
Class. 
Book. 



COPYRIGHT DEPOSIT 



MOTHER AND CHILD. 



PART I. 

MOTHER. 



MX 



EDWARD P. DAVIS, A.M., M.D. 



PART II. 

CHILD. 

/ BY 

JOHN M. KEATING, M.D., LL.D. 




92 






ttUir) X 



( 



PHILADELPHIA*. 

J. B. LIPPINCOTT COMPANY. 

London: io Henrietta Street, Covent Garden. 
I 893. 



\ 



^ nf> 



Copyright, 1892, 

BY 

J. B. Lippincott Company. 



Printed by J. B. Lippincott Company, Philadelphia, U.S.A. 



■j/16 



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PREFACE. 

We Lave endeavored to make this manual both instructive 
and readable. Our aim has been, not to supplant the physi-^ 
cian, but to supplement his advice and render intelligible 
those matters that mothers and nurses find difficult to under- 
stand. Although our own views are definite and positive, as 
the result of large experience, we recognize that the experi- 
ence of others causes them to differ in many points of detail 
and management, and in order to make our book cover as 
large a field as possible, we have added much material from 
the writings of other physicians whose opinions have great 
weight and whose advice is of incalculable value. Frequently 
a change of diet from a well-recognized formula to one possibly, 
in theory not so good, is most important for the child, and on 
that account we have endeavored to incorporate all the sugges- 
tions that experience has shown to be of value, at the risk of 
being prolix, that a choice may be made to suit each individual 
case. There are undoubtedly times when a competent physi- 
cian is not obtainable, also there are emergencies when some- 
thing has to be done at once, and consultation with books 
becomes a necessity ; under such circumstances we hope that 
our little work will prove useful. Then, again, frequently the 
physician has not the time to instruct his patient in all the 



4 PREFACE. 

little details of treatment, nor can he answer in a few words 
the many questions put to him ; we have tried to anticipate 
this, and to place in his hands a manual that, instead of en- 
croaching upon his prescriptions, will, on the contrary, aid him 
by instructing the mother and care-taker, — not sufficiently to 
make them inferior doctors, but enough to make them intelli- 
gent patients and skilful nurses. 

In order to more thoroughly individualize each part, it was 
thought advisable to adopt the plan here presented; but each 
author carefully revised the proofs of the whole book, and the 
views and recommendations are endorsed by both. 



CONTENTS, 



PART I. 



MOTHER. 

CHAPTER PAGE 

I. — Girlhood 9 

II. — The Period of Puberty . , 14 

III. — The Hygiene of Womanhood 17 

IV.— Conception 19 

V. — Symptoms of Pregnancy ., 21 

VI. — Duration of Pregnancy 22 

VII. — Miscarriage 25 

VIII. — Diseases affecting the "Woman during Preg- 
nancy . 26 

IX. — Hygiene of Pregnancy— Diet 29 

X. — Hygiene of Pregnancy — Exercise and Clothing 32 
XI. — Hygiene of Pregnancy — Bathing — Care of Ner- 
vous System 33 

XII. — Constipation 36 

XIII. — Hygiene of Pregnancy — Breasts — Varicose 

Veins , 37 

XIV. — General Hygiene of Pregnancy — Climate . . 40 

XV. — Nurse and Koom 42 

XVI. — Appliances for the Mother 45 

XVII. — Appliances for the Child 50 

XVIII. — Child's Cradle and Basket 53 

XIX.— Labor 56 

XX. — Puerperal Fever 60 

XXI. — First Few Days after Confinement 63 

XXII. — Mother's Becovery 70 

XXIII. — Diet and Lactation 74 



CONTENTS. 



PART II. 

G ZE3T I L ID. 

CHAPTER PAGE 

XXIV. — Care of New-Born Infant 79 

«^XXV. — Child's Navel and Intestines 85 

XXVI.— Care of the Brain and Nervous System ... 94 

XXVII. — The Nursing of Infants 97 

XXVII L— Bottle-Feeding 104 

XXIX. — Sterilizing and Sterilizers 110 

XXX. — How to Prepare the Bottle for a Healthy 
Babe from Birth to Two or Three Months 

of Age .... 119 

XXXI. — How to Prepare the Bottle for a Delicate 

Babe from Birth to Three Months of Age . 128 

XXXII.— Condensed Milk 132 

XXXIII.— Prepared Bottle 138 

XXXIV.— Weaning .;....... 154 

XXXV.— Menstruation 162 

XXXVI. — Education and School-Hygiene 179 

XXXVII- — Surgical Emergencies 241 

XXXVIII. — Fresh Air, Ventilation, Out-Door Exercise . 275 

XXXIX.— Bathing 298 

XL.— Teething 304 

XLL— Diet after Early Dentition . . . 317 

VXLIT.— The Bowels 336 

XLIII.— Constipation . 337 

XLTV.— Diarrhcea 348 

XLV. — Nursing of Sick Children 357 

XLVI.— Acute and Chronic Nasal Catarrh 380 

XLVII. — Diseases of the Eye 388 

XLVIIL— Diseases of the Ear 399 

XLIX. — Diseases of the Throat and Air-Passages . . 411 

L. — Whooping-Cough 424 

LI— Fever 429 

LII. — Scarlet Fever 434 

LIII. — Measles — Mumps — Varicella, or Chicken-Pox . 440 

LIV.— -Second Dentition 447 



PART I. 



MOTHER. 



BY 
E. P. DAVIS, A.M., M.D. 



MOTHER AND CHILD. 



CHAPTEE I. 

GIRLHOOD. 



It has been truly said that " the boy is father of the man," 
and it is not less true that the girl is mother of the woman. 
The foundations then for sound and healthy womanhood must 
be laid in girlhood, and the system thus begun must be con- 
tinued faithfully, yet with wise moderation, if it is to be of 
permanent usefulness. No subject is of greater importance in 
this connection than the hygiene of the girl's life. For the 
first ten or twelve years, her capacity for physical exertion 
and endurance is practically that of a boy of the same age. 
Although naturally inferior in muscular development later in 
life, during these first years she should be fully his equal in 
strength, endurance, and dexterity. At this time tastes should 
be encouraged and habits formed which may eventually prove 
most important in the maintenance of health. G-irls should 
be allowed to become interested in out-door sports during the 
first ten or twelve years of life, and habits of out-door ex- 
ercise should be fostered in every way. This plan must of 
course often be modified to suit individual cases, and excess of 
exercise is to be deprecated. Parents and teachers should 
watch children carefully to see that lasting injury is not done 
to the latter by over exertion. Tennis is a game that lends 
itself admirably to the vigorous and healthful use of the mus- 
cles, but what benefit can possibly come to a girl of twelve 
who plays so many sets that she finally drops fainting on the 
grass ? Emulation and the desire not to spoil the game for 

9 



10 MOTHER AND CHILD. 

the companions who depended on her to complete the necessary 
number of players, was the motive for this fortitude, but her 
young friends could better bear to be disappointed once than 
she could to injure herself physically for life. 

A love for animals, which is not uncommon in childhood, 
may be advantageously encouraged, and often gives increased 
zest to open-air enjoyments. When possible, a girl should be 
taught at the earliest opportunity to ride and drive. Skating, 
running, jumping, and climbing are quite appropriate exercises 
for girls of this age, while there can be no better time to per- 
fect the art of swimming than in the years from eight to 
twelve. The girl then knows little fear of the water, and 
swims readily, whereas later in life timidity often prevents 
the acquirement of such knowledge. She can be taught even 
at this early period to save a life in danger from drowning, 
and such instruction has not infrequently borne fruit in suc- 
ceeding years. The writer recalls two women who learned to 
swim in early girlhood, each of whom has saved lives by ability 
in this accomplishment, and one of whom has been honored by 
a medal from a Humane Society. There has also been great 
harm done, however, to girls by immoderate exertion in gym- 
nasium and swimming-school, especially in jumping from a 
height of many feet into the water beneath, and it must there- 
fore be remembered that it is the " use, and not the abuse," 
of these aids to physical development that makes the healthy 
girl and woman. 

There can be no objection to teaching the girl the use of 
the rifle and shot-gun, and giving her a taste for hunting and 
fishing, and many a husband has been delighted to find his 
wife capable of sharing in his sports by reason of an educa- 
tion given in her girlhood. The idea that it is hoidenish for 
a girl to practise physical exercise and enjoy out-door sports is 
one of the prudish superstitions which has done much to re- 
tard the physical development of American women. A knowl- 
edge of the use of fire-arms is also of decided value to a girl 
in enabling her to be calm and courageous under various con- 



GIRLHOOD. 11 

ditions of threatening danger. The tortures suffered by many- 
girls and women in the thought of a possible attack by burglars 
would probably disappear, certainly be much lessened, by the 
assurance of possessing the power of self-defence. America 
might not be now the land " of the free and the brave" if the 
"women of the first century" (unlike their sisters of a later 
date) had not cultivated the use of weapons, and nerved them- 
selves to feats of personal heroism in order to resist the onset 
of treacherous or desperate Indians. There is no fear that the 
pursuit of such qualifications will detract from the gentleness 
and delicacy of feeling which should characterize girlhood, for 
it is a well-known fact that the pioneer women just alluded to 
were as remarkable for feminine charms as for the undaunted 
bravery which was formerly thought the distinctive mark of 
the stronger sex. 

The domestic nature of the girl rarely needs stimulus ; she 
is usually willing to learn to sew, and to acquire familiarity 
with the household arts essential to a truly useful woman. 
Many children exhibit also a decided taste for music or draw- 
ing ; if an ability for the latter is manifest, the child will enjoy 
reproducing to the best of her power some favorite bit of 
scenery, or the head of a pet animal, and thus a knowledge of 
out-door life will directly foster an artistic instinct. Too much 
importance can scarcely be laid upon the out-door element in 
the girl's life, for there can be no more potent factor in laying 
the foundations for healthy womanhood than the vigor attained 
through out-door exercise. 

The dress of the girl should be adapted to permit the freest 
possible movement ; she should be supplied with thick-soled, 
low-heeled shoes, well fitting, but sufficiently large to encour- 
age walking and running. Fashion should be subservient en- 
tirely to health, comfort, and encouragement of exercise. The 
nutrition of a child so educated will require little attention be- 
yond the furnishing of an ample supply of thoroughly nutri- 
tious food, but this point of properly nourishing growing girls 
needs much more care and thought than the average American 



12 MOTHER AND CHILD. 

mother seems inclined to bestow upon it. The nervous waste 
occasioned by constant exercise must be repaired by abundant 
and wholesome food, if the girl is to develop into a thoroughly 
healthy personality. . Ten hours of sleep should be the rule, 
and sponge-bathing in either warm or cold water should be 
practised daily. It is well known among athletes that exercise 
and cold sponging produce a marvellously clear complexion, 
and as the foundation of woman's beauty is laid in girlhood, a 
hint may be taken from athletes in this respect. Complete 
sponging, followed by energetic rubbing with the rough towel, 
produces a delightful feeling of exhilaration, and is succeeded 
by improved circulation. 

The girl should be carefully guarded from stimulants and 
narcotics in every form. Neither tea, coffee, nor alcohol should 
be given, nor should opium or other narcotics be administered 
for trivial ailments unless by the direct prescription of the 
physician. An excessive use of tea in this country is doing 
much to weaken the nerves of women, and is an evil tendency 
that may lead to serious consequences in producing permanent 
feebleness of constitution. A morbid appetite for candy, 
pickles, and other abnormal articles of food should be promptly 
suppressed in girls, and the helpful effects of really nutritious 
articles carefully explained, as these vagaries of appetite often 
arise from thoughtless ignorance of the laws of health and 
strength. 

The mental education of the girl should not be made a mat- 
ter of routine memorizing ; the child should learn to read, to 
write, and to count, but beyond this it is quite unnecessary to 
go until young womanhood is attained. An education, how- 
ever, of the best sort is to be gained during this period by ob- 
servation of the external world, and by the conversation and 
example of older persons with whom the child is thrown. How 
often a girl of twelve or thirteen accompanies her parents 
through Europe, and instead of using her eyes and brain, while 
travelling in the railway carriage, to note the interesting and 
novel objects around her, is buried deep in a romantic tale, use- 



GIRLHOOD. 13 

fill and entertaining in its proper season, but not to be com- 
pared in its educational power, at such a time, with the devel- 
oping force of observation of nature and human character! 
While habits of regularity can be formed by certain definite 
times for study, yet application to books in-doors should never 
exceed a half-hour at any time. If the girl is to grow to 
womanhood with sound eyes and healthy nerves, she should 
not be obliged to apply herself assiduously to books in-doors. 
These statements may seem to the reader dogmatic and ex- 
treme, but they are founded upon the observation of women 
suffering from physical imperfections which began during the 
period of girlhood. It would probably be dim cult to find a 
school, college, or institution of instruction for girls anywhere, 
in this country, which is based upon this plan of study of 
books at school and dispensing of books at home ; but if such 
a system were to be adopted, there is little doubt that there 
would result a vast improvement in the health of the Ameri- 
can girl. When it is remembered that without individual 
vigor, a knowledge of all the sciences that exist will be of 
very slight value in rendering a woman happy and useful, it 
seems as if it might be worth while to sacrifice an acquaint- 
ance with Greek and trigonometry if the girl by such study is 
losing the opportunity of cultivating physical strength and 
endurance. 

The life of the healthy girl is an exceedingly happy one ; 
she finds no better friend or companion than kind parents or a 
congenial brother : prudery and tradition have not yet taught 
her that she is to be hedged about with many restrictions upon 
her taste and ambitions, and the happiest days of life in mind 
and body are often passed at this period. 



14 MOTHER AND CHILD. 

CHAPTBE II. 

THE PERIOD OF PUBERTY. 

The development of the girl to womanhood exposes her to 
dangers which demand careful consideration. If it be remem- 
bered that the normal performance of the function of menstru- 
ation is almost directly dependent upon the general physical de- 
velopment of the woman, it will be seen that the hygiene of 
girlhood is the best preparation for healthy womanhood. The 
establishment of the functions of womanhood occurs at different 
ages, varying with the climate in which the girl lives and her 
individual peculiarities of temperament. If a warm climate 
and an out-door life have predisposed to early performance of 
physical functions, this may be established in the twelfth or 
thirteenth year ; on the contrary, if climatic influences are ad- 
verse, if the individual be naturally slow in maturing, and if 
those influences which stimulate unduly the nervous system 
be kept from the girl, the establishment of menstruation will 
occur as late as the fourteenth year or subsequently. As a 
preparation for this important function, all extra strain upon 
the nervous system should be assiduously avoided in this cli- 
mate after the years of twelve and thirteen. The girl need 
not be told the reason for this, except, in a general way, that 
she is growing older, and ought not to do as she has done 
three years previous. It is her mother's duty, however, to see 
to it that at this time she leads as tranquil and healthy a life 
as possible, in which the emotional nature is little disturbed, 
while abundant sleep, fresh air, and freedom from nervous 
strain are jealously secured for her. If the girl loses appetite 
and seems generally depressed, a physician should be consulted ; 
he may discover some poverty of blood, or deficiency in general 
vigor, which may be easily remedied by an appropriate tonic. 
It is most unwise, however, for mothers to select at random 



THE PERIOD OF PUBERTY. 15 

one of the many patent medicines advertised in the market as 
specifics in this condition ; it should also be remembered that 
menstruation is rarely established with regularity for several 
months after its first appearance. A period of six months or 
a year is often observed before this function is performed at 
regular periods. Irregularity, then, at first need occasion no 
alarm provided the general health remains good. When the 
first symptoms of menstruation appear, especial caution should 
be exercised that the girl's clothing be warm, loose, and com- 
fortable. The administration of a simple laxative is often of 
value, while the use of the hot mustard foot-bath, absolute 
rest in a warm bed, the application of warm cloths to the 
abdomen, and the moderate use of hot but not stimulating 
drinks, have been often found of value. Although alcoholic 
liquors, either gin, rum, whiskey, or brandy, are often taken 
by adults to relieve distress at this time, yet the mother will 
do well to avoid these stimulants in caring for her daughters ; 
a taste for alcohol is too easily formed to render it safe to ad- 
minister these substances to secure the performance of a natu- 
ral function. There is no drug or medicine which a mother 
may safely give to her child at this time without the advice 
of a physician. Those nostrums in the market which are 
potent for good owe their value to some familiar drug which 
should be prescribed by a physician only : the vast majority 
of these medicines are inert, and of no value whatever. It is 
most important that absolute rest be enjoined during the first 
day or days of this period while it is about to be established, 
and the neglect of this simple precaution has often resulted in 
exposure, and in laying the foundations of lasting disease. The 
wetting of the feet, sitting in damp clothing, and the incurring 
of great fatigue at this season, are perils which, if thoroughly 
understood, would be shunned as serious dangers. Circum- 
stances point plainly to this period in the life of the woman 
as a time in which she is poorly fitted to assume active duties. 
The girl loses the freedom of motion and the careless good 
health of happy childhood : she becomes easily embarrassed, 



16 MOTHER AND CHILD. 

awkward in action, and often shy in disposition. At the same 
time, new matters and ideas are developing in the mind, and 
need wise guidance into proper channels. At this period the 
girl should have the best and wisest nurses : one of those is 
her mother, the other is Nature, or the world about her. As 
the flowers mature best under the influence of the quiet forces 
of sunshine and moisture, so the physical and mental being is 
best unfolded to the stimulus of a simple life and the compan- 
ionship of maternal affection. No more injurious course of 
action can be taken than to urge a girl at this period to enter 
general society, to apply herself assiduously in any occupation 
or study which taxes the nervous system, or to indulge in 
those romances which often end in laying the foundations for 
future sorrow, if the girl be not protected by those wiser than 
she. It is a false and foolish parental ambition or indifference 
which refuses to listen to the growing girl's complaint of lassi- 
tude and disinclination to exertion at this time ; this is not the 
period when such desires are the result of hypochondriasis or 
indolence ; but the disposition to avoid great exertion and to 
husband the strength as much as possible is natural and right. 
Such tendencies should be met by careful scrutiny and a sym- 
pathetic, intelligent apprehension of the needs of the individual. 
While there are many boarding-schools which are presided 
over by wise teachers and guardians, it is far better for the 
girl at this time if she can be under the tranquillizing influences 
of a congenial home ; class rules which cannot be infringed 
upon for the sake of any one pupil (unless she be wholly in- 
capacitated) often oblige her to undergo more exertion than 
she is physically qualified to meet ; neither does she always 
receive the right kind of nourishment, nor has the teacher 
time to note and remedy a failure of appetite or vigor. 



THE HYGIENE OF WOMANHOOD. 17 

CHAPTEE III. 

THE HYGIENE OF WOMANHOOD. 

In the climate of the United States, and under average cir- 
cumstances, womanhood may be said to begin at from eighteen 
to twenty years of age. If her previous years have been 
spent in surroundings calculated to secure good health, the girl 
will find herself possessed of strength sufficient not only for 
the ordinary domestic duties of life, but, should necessity de- 
mand it, to engage in some occupation for her livelihood. No 
matter whether she is obliged to maintain herself, or whether 
her ambition leads her into the arduous idleness of fashion, if 
the health and strength are to be preserved, the same precau- 
tions must continue which were enjoined during childhood. 
The clothing should remain well fitting, loose, and comfortable. 
Corsets should be left to those more ignorant and stupid than 
herself, and habits of exercise out of doors, the use of nutri- 
tious and easily-digested food, and the securing of a sufficient 
supply of sleep are still of vital importance. The most suc- 
cessful women understand perfectly the need for constant care 
in the preservation of health and beauty. The popularity of 
massage, the increased number of attractive health resorts, 
and the wide-spread interest in out-door athletics for women. 
as well as physical culture in-doors during the winter, give 
ample evidence of this fact. The additional suppleness, grace 
of movement, and elasticity of the whole body, attained by 
conscientious practise of the physical culture exercises, prove 
a more than sufficient reward for the time and energy bestowed 
upon them. 

An opportunity is given in the early spring, with the sanc- 
tion of the church, to avoid overtaxing in the loss of sleep 
and bad eating which the fashionable season imposes. The 
great desire to possess homes in the country, in addition to 
b 2* 



18 MOTHER AND CHILD. 

city houses, has resulted in shortening the period of city life, 
so that, at the present time, many live in town but a third of 
the entire year. This is a distinct gain in the health and com- 
fort of those who are fortunately able to follow this custom. 

Among those who are obliged to work for a livelihood, suita- 
ble materials for proper clothing can be obtained at lower j)rices 
than formerly, and light woollen stuffs, which are so essential 
to health, are far more available than in former times. Food 
is better cooked in the average boarding-house and restaurant, 
to which women have access, than was the case ten or twenty 
years ago. A greater variety is afforded for a moderate price, 
and the maintenance of a fair condition of nutrition is thus 
within the reach of nearly all. 

Yery few workers in any pursuit are unable to obtain a 
summer holiday, however brief. Women are now offered 
lodgings, food, and care in various homes and hotels maintained 
for working- women, which give them the conditions necessary 
for health at the lowest possible prices. The heating and ven- 
tilation of shops and factories are better than formerly (although 
there is much still to be desired in this respect), and the use 
of machinery, of elevators, and other labor-saving devices, 
has reduced some injurious forms of muscular exertion very 
greatly. 

The increased opportunities for practising stenography and 
type-writing have given women an occupation which, under 
favorable circumstances, is not hurtful to those of average 
strength. 

Training-schools for nurses offer a safe, honorable, and lucra- 
tive employment, for which women are especially well fitted, 
to those of good constitution and sound nervous system. No 
others can become successful nurses, but such can derive good 
incomes, and if they possess sufficient education and executive 
ability, can secure, as superintendents of schools and hospitals, 
those medical positions for which women are best adapted. 

When American civilization advances sufficiently to furnish 
a class of properly- trained women for house service, one of 



CONCEPTION. 19 

the most puzzling problems in securing healthy occupations 
for women will be solved. At present, the young woman 
coming to the city often prefers to stand behind a counter, 
adorned with cheap jewelry, as a ■" saleslady," when she could 
earn more money at less expense to herself and under condi- 
tions favorable to health as a trained waitress, child's nurse, 
seamstress, or maid. American democracy has placed these 
pursuits in an unfavorable light in the minds of women, and 
they are regarded as menial and undignified. A change in this 
can of course result but gradually, but when it shall come, the 
lives and health of many women will be preserved, which are 
now injured or lost by the disadvantageous surroundings found 
in many large shops and factories. 



CHAPTEE IT. 

CONCEPTION. 



The conditions influencing conception are so many and so 
different that a brief consideration of them can hardly fail to 
be of interest. It has been asserted by some authorities that 
conception occurs more frequently in the months of spring 
than in midsummer or midwinter. Next in frequency the 
autumnal months are given. It is well known that the gen- 
eral condition of a nation as regards plenty or famine, pros- 
perity or adversity, war or peace, freedom from excessive labor 
or necessity for toil, influences in a very marked degree the 
increase of population. In a general way climate also has 
something to do with the growth of the human family. The 
portions of the globe where man survives under the greatest 
difficulties by reason of the severity of heat or cold show, as a 
rule, less flourishing families than the more temperate regions. 
Eegarding the age at which conception is possible, we find 
that it varies from the period of puberty to several months 



20 MOTHER AND CHILD. 

and, in some rare cases, several years after the cessation of 
menstruation. Conception often occurs about the " change of 
life." 

So far as age in years is concerned, this changes in different 
races and different climates, but the fact is familiar that in the 
tropics women bear children earlier and cease reproduction 
sooner than in temperate or cold climates. So far as the con- 
ditions favoring conception in individual cases are concerned, 
the many circumstances which make up the life of the wife 
have considerable influence. The years of greatest fecundity, 
when reproduction is least injurious to the woman and when 
children are born best developed, are between the years of 
twenty and thirty. Great unhappiness, severe nervous shock, 
prolonged ill health, and, in general, any excessively depressing 
and persistently acting influence may result in the suspension 
of the reproductive function. So far as the estimation of the 
time between the periods of menstruation when conception is 
most likely to occur, the former belief has been that immedi- 
ately after the cessation of the monthly period liability was 
greatest. 

More recent investigations have led us to believe that the 
four weeks or thirty days between the menstrual epochs may 
be divided into three periods of ten days each. During the 
first ten days after menstruation and during the ten days im- 
mediately preceding the next period, liability to conception is 
greatest. In the ten days between these periods, liability is 
less. Exceptions, however, to all rules and estimates, and to 
all methods of computation, are so frequent that no fixed rule 
can be given, and it must be understood that liability is always 
present, whatever may be the time, during the inter-menstrual 
period. 



SYMPTOMS OF PREGNANCY. 21 

CHAPTEE V. 

SYMPTOMS OP PREGNANCY. 

The symptoms of pregnancy are naturally divided into the 
presumptive and the positive. The most frequent presumptive 
symptom is cessation of menstruation, and yet, when we con- 
sider the many causes which may disturb the regular course 
of this function, it can readily be seen that this is far from 
being a positive symptom, and is, in fact, only the most com- 
monly-observed presumptive symptom. Any unusual strain 
upon the vital powers, change of climate and residence, expo- 
sure to cold or to extreme heat, the disturbances incident to 
marriage, and, in general, any great depression of the woman's 
physical economy, or any sudden change in her environment, 
may result in the temporary suspension of menstruation. 
This may persist for several months without serious disease 
being present, and as the general balance of the economy is 
restored, so the function becomes re-established. Other pre- 
sumptive symptoms of pregnancy are a sensation of weight 
and fulness in the abdomen, enlargement of the breasts, with 
tenderness about the nipples, marked variation in the appetite, 
with desires for unusual sorts of food, all intensified by a 
strong desire for, and belief in, the occurrence of pregnancy. 

In rare cases, abdominal enlargement may even proceed to 
the size attained at the end of normal pregnancy, and still 
pregnancy may not exist. While too much stress should not 
be laid upon the presumptive symptoms of pregnancy, yet 
disturbance of menstruation and variation in the general 
health should arouse the woman's suspicions, and should lead 
her to consult her physician at once. He may be able to de- 
tect some temporary disorder which treatment may remedy, 
or his experienced scrutiny may determine the existence of 
pregnancy. So soon as presumptive evidence of pregnancy is 



22 MOTHER AND CHILD. 

observed, the woman should avoid fatigue and extremes of 
every sort, and maintain the best possible general condition 
of health until her condition can be definitely ascertained. 

The positive symptoms of pregnancy are present when the 
child is sufficiently advanced so that its existence can be appre- 
ciated by the physician by the senses of hearing, of touch, or 
of sight. By these we mean that when the physician can 
hear the heart-beat of the child within the womb ; when by 
placing his hand upon the abdomen he can feel distinctly the 
movements of the child, and by watching closely the surface 
of the abdomen as the mother is resting quietly in a recum- 
bent position, can observe slight movements which are occa- 
sioned by the motions of the child's limbs within the womb, 
then the positive existence of pregnancy is established beyond 
doubt. Ordinarily, however, it is quite sufficient for the physi- 
cian to hear the beating of the child's heart, and this can 
usually be done soon after the fourth month of the child's ex- 
istence. In repeated pregnancies, the mother can often from 
experience assert positively regarding her condition ; but even 
the sensations of an experienced mother are occasionally at 
fault, and so a positive verdict must be deferred until the 
physician can demonstrate the existence of the child. 



CHAPTEE VI. 

DURATION OF PREGNANCY. 

It is well to define the terms used to express the premature 
birth of the child, and also the limits to the time in which a 
child may be born and survive. By the word viability we un- 
derstand the child's ability to survive when expelled from the 
womb. Modern methods of treatment have made it possible 
for children to live and thrive when born between six and 
seven months after conception. If a child is expelled from 



DURATION OF PREGNANCY. 23 

the womb in the first four months of pregnancy, it is com- 
monly called an abortion. If the expulsion takes place after 
the fourth month, but before the time when the child is viable, 
it is known as a miscarriage, and if the child is born after the 
period of viability, and yet before the usual limit of pregnancy, 
it is known as premature labor. 

This brings us to consider the natural limit of pregnancy in 
the human species. It was formerly supposed that from two 
hundred and seventy to two hundred and eighty days was the 
usual period of gestation, but recent study has shown that 
while it is true in the majority of cases, yet occasionally gesta- 
tion may be prolonged to three hundred days, and even more, 
and still a perfectly healthy child be born after a safe and 
speedy labor. 

On the other hand, it is not infrequent for children to be 
born at any time between the two hundredth and two hun- 
dred and eightieth day after conception, and survive and flour- 
ish. Keeping these facts in mind, we can readily explain the 
miscalculations which occasionally arise, and the fact that 
children are sometimes born before their mothers are ready for 
them, before the arrival of the nurse, and when they are quite 
unexpected ; and again, a delay of several weeks may occur, 
giving rise to much annoyance and anxiety, and yet the whole 
be simply a delayed process. If we ask ourselves in what 
consists a perfectly healthy pregnancy, we may define it some- 
what as follows : It is the natural growth and development of 
the child in the womb, extending through a period, on the 
average, of nine months, and resulting in the birth of a child 
sufficiently strong to subsist with the aid of the mother's care. 

During this time, changes go on in the body of the mother as 
the child grows and develops. She frequently gains somewhat 
in weight, and increase in all of the tissues of her body takes 
place. As pregnancy progresses, the organs of respiration 
and digestion become encroached upon by the growing child, 
and hence modifications in every function result, which are 
adapted to the increased demand made upon her respiratory 



24 MOTHER AND CHILD. 

and digestive functions. She is obliged to breathe and to 
digest for two, and hence in many instances a feeling of well- 
being and an increase of appetite take place. In other cases 
the burden of the new life seems excessive, and weakness and 
prostration may denote that her powers are unequal to the 
task ; but in the main, among healthy women, after the first 
months are past, the general health is in a condition of com- 
parative vigor. The wonderful changes which go on during 
these nine months are but imperfectly understood by even 
scientists. It is sufficient to say that if the mother remembers 
the dual life which she is leading, and that there is developing 
within her a being which not only breathes through the oxygen 
contained in her blood, but in addition is forming a nervous 
system, and receiving through her nervous system the trans- 
mission of some of the sensations which she experiences, the 
meaning and scope of what is meant by a natural pregnancy 
become more apparent. 

We introduce these apparently abstract scientific remarks to 
impress upon the minds of mothers the fact that their habits 
and environment during the period of pregnancy are forming 
not only the shape and size and health of the unborn child, 
but also its mental and physical peculiarities. It should be 
remembered that a normal pregnancy is a distinctly natural 
and physiological process ; that certain tissues and develop- 
mental forces resident in the woman's body have been given 
to her fbr this purpose, and that her forebodings and dread are 
to be tempered by the thought that she is thus fulfilling a 
design which results, in the healthy person, not in disease nor 
in death, but in the performance of a function which is part 
of her healthy life. 



MISCARRIAGE. 25 

CHAPTER VII. 

MISCARRIAGE. 

It is necessary that we should also describe abortion and 
miscarriage, and draw attention to dangers which attend them. 
The two symptoms of abortion and miscarriage, which should 
at once arouse solicitude, are flooding and pain. They denote 
that the child is in danger of being separated from the womb, 
or that such separation has already occurred. This may be 
caused by disease on the part of the mother, and especially 
frequently by undue exertion or violence. Thus, as in a case 
which we recall, the use of a sewing-machine for half a day, in 
a woman who was not accustomed to active work, resulted in 
abortion. Thoughtless lifting or undue exertion in reaching 
up to high shelves, or hanging up clothing, has also caused 
abortion. A sudden shock, as falling down stairs, or being 
thrown from a carriage, or severely jolted upon a rough road, 
or in an elevator, or upon a railway train, has resulted in this 
accident. 

Occasionally, in persons who seem predisposed to abortion 
or miscarriage, a very slight jar will bring on this misfortune. 
Thus, a mis-step in the street has caused abortion. Sudden 
nervous or mental shock, grief and terror, have been repeatedly 
effectual ; in great disasters, where a city has been burned, or 
where a section of country has been suddenly attacked by a 
hostile army, or in time of sudden disaster of any sort, as 
during the Johnstown calamity, large numbers of women suf- 
fered from abortion or miscarriage. 

The occurrence of flooding and pain in a woman who is preg- 
nant should lead to her placing herself instantly at perfect 
rest, and sending for her physician. She should lie down, 
loosen her clothing, keep absolutely quiet, and summon medical 
aid as soon as possible. The dangers of such accidents are the 
b 3 



26 MOTHER AND CHILD. 

bleeding which accompanies them, and the fact that, unless 
especial care is taken, women frequently do not recover health 
promptly, but suffer from various disorders afterwards. The 
physician's treatment and orders should be strictly carried out, 
and especially in the matter of remaining absolutely quiet 
until he gives permission to move about. Women not infre- 
quently think that rest in bed for a week or ten days after 
hemorrhage has ceased is quite sufficient for perfect recovery. 
This, however, is very rarely true, and frequently the avoid- 
ance of exertion from eight weeks to three or four months is 
needed to result in perfect restoration to health. If the physi- 
cian's limit as to remaining recumbent were more generally 
observed, women would suffer far less frequently from the con- 
sequences of these accidents. 

If women are so situated that they cannot obtain medical aid 
promptly, and flooding and pain continue, by keeping absolutely 
recumbent, the head low upon the bed, possibly without a pil- 
low, and by the exercise of the greatest cleanliness while the 
hemorrhage persists, they will do all that they can to favor 
a good recovery. It is especially important that, should a friend 
be present sufficiently experienced to understand what is going 
on, she should abstain in any way from touching the bag of 
fluid in which the child is contained until it has been expelled 
from the mother's body. Otherwise, she may precipitate a 
dangerous complication. 



CHAPTEE VIII. 

DISEASES AFFECTING THE WOMAN DURING PREGNANCY. 

Diseases occurring in pregnant women commonly occasion 
more than usual anxiety on the part of the patient and her 
friends. This anxiety is based upon good grounds, for if a 
pregnant woman becomes ill with some acute disease, her 



DISEASES DURING PREGNANCY. 27 

pregnancy adds greatly to her danger. In fevers, occurring in 
such patients, the danger to mother and child becomes great 
in proportion as the patient's temperature is high and remains 
considerably elevated. Thus, in typhoid fever, in malarial 
fever, in rheumatic. fever, and in pneumonia, often known as 
lung fever, if the patient's temperature does not rise very 
high nor remain elevated for a considerable time, the patient's 
chances for recovery and those of her child are much better 
than if the fever is severe and prolonged. If abortion should 
occur during an illness, it is an injurious accident for the 
mother. She is apt to have severe flooding, and there is danger 
that some form of inflammation will attack the womb. 

It sometimes happens that the organs in the body which 
remove waste materials from the blood fail to property perform 
their functions during pregnancy. This results in the storing 
up of poisonous material in the patient's body, and when this 
poisonous matter becomes sufficiently abundant, it poisons the 
brain and spinal cord, and causes convulsions. This is known 
as eclampsia, or convulsions occurring in pregnancy. They 
are likely to come on sometimes without warning, and more 
often after the patient has suffered with headache, dimness of 
vision, a sense of heaviness and lassitude, accompanied by a 
gradual diminution of the product of the kidneys. Symptoms 
such as these, when observed by a nurse or by the patient her- 
self, should cause her to instantly consult her physician. 

Eclamptic convulsions occurring during pregnancy resemble 
epileptic fits ; they are more dangerous than epileptic fits, for 
many patients die in this condition. The convulsions usually 
bring on the labor, and the child sometimes survives and often 
perishes. If the patient suffers from headache, lack of vision, 
and diminished amount of kidney secretion, no time should be 
lost in communicating with her physician. 

It has long been a tradition that women who have incipient 
consumption become better in health if they marry and bear 
children; this is one of the many groundless beliefs extant. 
It is true that during the pregnancy the mother's health and 



28 MOTHER AND CHILD. 

strength may improve under the influence of the increased nu- 
trition which pregnancy brings : so soon, however, as the preg- 
nancy ends, the disease which existed before pregnancy began 
goes on with increased severity. It is wrong for women who 
have incipient consumption, or for women who have a strong 
hereditary tendency to consumption and are themselves not 
robust, to marry and bear children. If this truth were ac- 
knowledged, much would be accomplished to check the spread 
of consumption. There is also a possibility that the child, 
when born, will be found affected by the same disease. A 
woman suffering from consumption should by no means nurse 
her child, as there is danger of conveying tuberculosis through 
her milk. 

Nervous diseases sometimes develop during pregnancy, and 
among these, St. Yitus's dance is not uncommon. Insanity is 
sometimes precipitated by pregnancy and the puerperal state. 
Where the mother has been healthy before she became preg- 
nant, she will probably recover her mental condition in a short 
time after the child is born. Where, however, the mother has 
a strong tendency to insanity, the chance for her permanent 
recovery is not so good. 

It has always been thought that pregnant women were 
especially liable to those diseases which are accompanied by 
eruptions : this opinion is well founded. The danger in these 
cases arises from the fever which accompanies them, from the 
liability to interruption of the pregnancy, and the danger of 
blood-poisoning which complicates such an accident. Cases of 
extraordinary resistance to such contagion are occasionally 
observed, and women have been known to nurse a child 
suffering from scarlatina without themselves contracting it. 
Such could scarcely be the case if the woman were pregnant 
and cared for another child ill with scarlatina. Where abortion 
or labor occurs in these cases, especial precautions regarding 
cleanliness should be observed, as the danger of blood-poison- 
ing is much greater than ordinarily. 

Women who have disease of the heart are often exceedingly 



HYGIENE OF PREGNANCY— DIET. 29 

anxious lest pregnancy should terminate in a dangerous and 
severe labor. Fortunately, such fears have no great basis for 
their existence. It is remarkable how women who have 
suffered from heart-disease for many years will pass through 
a pregnancy and labor not only without growing worse, but 
oftentimes with apparent improvement. A patient's fears 
upon this point are happily generally without foundation, for 
when pregnancy terminates in labor, a remarkable degree of 
strength is often developed in the action of the heart. Women 
may receive severe injury during pregnancy from accidents, or 
from assault in occasional cases ; it is the rule, however, that 
if the mother be healthy, the pregnancy is often not inter- 
rupted, but the mother may recover, and the child continue to 
live until term. 



CHAPTEE IX. 

HYGIENE OF PREGNANCY — DIET. 

There can be no more important subject than the hygiene of 
pregnancy, and, as would be naturally inferred, the question of 
food is of the greatest interest. There are prevailing certain 
absurd ideas regarding the influence of the mother's diet upon 
the size and development of the child. It is alleged that by 
maintaining a continuous diet of fruit, and by carefully avoiding 
such articles of food as would contain matter nutritious for 
the child's skeleton, that children of small size and with easily- 
moulded and soft heads will be born as a consequence. While 
it may be possible by starving the mother to starve her child, 
yet no more injurious practice could be followed than one 
which diminishes the strength of the mother, and brings her 
to face the ordeal of labor with impoverished blood and de- 
pressed nervous system. 

The contrary is true, — that the patient needs a most abundant 
and easily-digested diet which shall be rich in nutrient material 

3* 



30 MOTHER AND CHILD. 

in proportion to the demands upon her for her own nourish- 
ment and that of her child. The question of drink during 
pregnancy is one which must be determined by reference to 
the usual habits of the patient. If she has been accustomed 
to drink wine and beer, there would bo no objection to her 
continuing the practice in moderation. But if not, she will 
do well not to commence the use of stimulants while pregnant. 
The question of diet, however, is greatly influenced by the 
irritability of the patient's stomach and her incapacity to 
digest large quantities of food, which are especially pronounced 
during the first four months. 

The phenomenon known as morning sickness may be de- 
scribed as follows : Soon after waking in the morning, and 
usually as soon as the head is raised from the pillow, the 
patient is suddenly seized with a desire to empty the stomach. 
When this desire is gratified, the sensation of nausea disap- 
pears, and soon after the patient is able to take a little food. 
In perfectly healthy women, where this derangement does 
not become severe, no treatment is necessary; if the patient 
drinks a glass of water and then ejects it at once, no harm is 
done, and in a few moments she will often be able to retain 
food. Yery frequently, this disagreeable symptom may be 
avoided by taking a small quantity of very easily digested 
food before the head is raised from the pillow. A little stimu- 
lant will prove effectual when food does not. Thus, a cup of 
well-made broth, rather highly seasoned and hot; a small cup 
of cocoa, tea, or coffee, especially black coffee ; a small glass 
of champagne, other wines, or bitter ale or beer; sometimes a 
little cordial, as Chartreuse ; brandy and soda, koumiss, and in 
hot weather a very little ice-cream,— all these are occasionally 
successful in giving relief, and in promoting an appetite for a 
subsequent breakfast. 

The patient must understand that the trouble is what is 
known as reflex ; that the growing of the child in the womb 
produces some irritation about the womb which is transmitted 
along its nerves to the nerves of the stomach. As a rule, 



EVGIENE OF PREGNANCY— DIET. 31 

when four months of pregnancy have passed, this disorder 
ceases, and usually a good appetite is enjoyed for the remainder 
of the time. 

We desire to warn the patient against using drugs of any 
sort for morning sickness. When excessive acidity of the 
stomach is present, bicarbonate of sodium, or the soda-mint 
sold in the shops will be of use, but narcotics and remedies 
addressed to the nervous system should be taken upon a 
physician's prescription only. The appetite of the pregnant 
woman is likely to be peculiar, and, in fact, a number of cases 
are on record where the first intimation that the woman had 
of her condition was a sense of delight or of loathing at the 
existence of some especial article of diet, generally a reversal 
of the usual appetite. 

Pregnant women frequently seem to have excessively abnor- 
mal appetites, which are known as " longings." If these be 
analyzed, they will usually be found to be expressions of de- 
sire for the sort of food which will best nourish herself and 
her unborn child. A hint may often be taken from these long- 
ings, and the needed article of diet may thus be supplied to 
the patient. 

If food is important during pregnancy, it must be remem- 
bered that digestive power is commonly so lessened that a 
smaller amount than usual can be digested at any one time. 
Hence it is often necessary not to take three full meals in 
twenty-four hours, but to have five or six lunches or lighter 
meals instead. These may be taken at intervals of four or 
five hours, and are often admissible at such intervals as to come 
after the patient has lain down and slept for a short time. 



32 MOTHER AND CHILD. 

CHAPTER X. 

HYGIENE OP PREGNANCY — EXERCISE AND CLOTHING. 

If proper nutrition is important for the pregnant woman, 
it must be remembered that there is no agent so efficient in 
producing this as sleep. Eest and sleep should be taken with 
regularity and abundance ; eight or nine hours at night, and 
from one to three during the daytime, are not too much for a 
person of average development. If sleep is interrupted, rest 
can often be taken at intervals most convenient. This should 
consist not only in the semi-recumbent position in a chair, but 
also in lying on a comfortable couch or bed. It quite often 
happens that if the child be vigorous, its movements within the 
womb may prevent sleep at night, and then rest in the day 
may be substituted. 

To keep up the condition of comfortable health, exercise is 
fully as important as food and sleep. Best of all is walking 
in moderation. Climbing stairs, lifting, running a sewing- 
machine, moving the arms rapidly, and excessively long walks 
are all extremely injurious, and likely to produce subsequent 
trouble; but a walk carefully graduated to the patient's 
strength and sensations in the earlier months of pregnancy, 
and driving in a comfortable vehicle in the latter months are 
especially indicated. The amount of housework incumbent 
upon a woman in comfortable circumstances usually suffices in 
ordinary cases. 

Exercise, however, will be uncomfortable and impossible 
without injury unless the patient is properly dressed. The 
very word enceinte denotes a person who is not wearing clothing 
closely belted about her. So soon as pregnancy is discovered, 
the ordinary corset should be laid aside. Some form of clothing 
should be adopted which supports the skirts upon the shoul- 
ders. There are a number of these devices in the market, 



BATHING— CARE OF NERVOUS SYSTEM. 



33 



Fig. 1. 



and the patient must choose that which fits her most com- 
fortably. 

Even in moderately warm weather, woollen underclothing 
should be worn. In winter, the Jaeger system of woollen 
underwear, and in warm weather, the finer and thinner goods 
similar are best, and should cover the body to the wrists and 
ankles. Garters should be made as loose as possible, or, better, 
discarded for some other device. ~No portion of the clothing 
should fit tightly, and should support fur the abdomen be de- 
manded, an abdominal bandage, or 
waist coming from the shoulders 
over the abdomen, may be em- 
ployed. In driving, great care 
should be taken that wraps are 
always within reach to avoid chill- 
ing the surface of the body. Easy 
shoes, loose-fitting wraps, and those 
forms of clothing which allow the 
freest movement of the chest should 
be worn. It is almost needless to say that, in the changeful 
climates of this country, thin woollen should be worn next to 
the skin for at least ten months of the year. 




Abdominal bandage for support 
in pregnancy. 



CHAPTEE XL 



HYGIENE OP PREGNANCY — BATHING — CARE OP NERVOUS SYSTEM. 



The care of the skin is a very important detail; the bath 
should be daily, avoiding extremes of hot or cold water, to be 
taken in the manner least likely to fatigue the patient, fol- 
lowed by gentle friction, and by repose in a recumbent posture 
for at least half an hour. A very disagreeable itching and 
burning in some parts of the body frequently occur during 



34 MOTHER AND CHILD. 

pregnancy. The advice of the physician should bo at once 
sought, and occasionally the patient can do much to relieve 
herself by dissolving in the water of the bath sufficient sodium 
bicarbonate to give a smooth feeling to the fingers, or, occa- 
sionally, a warm bath into which bran has been mixed will be 
found an advantage. 

The nervous system of the patient undergoes modifications 
fully as great as those of other organs. In the beginning, a 
period of despondency may occasion great anxiety on the part 
of the patient and her friends. She will often urge her physi- 
cian to relieve her from the continuation of her condition, 
fearing its results for the child and herself. Other women 
feel much better than usually when in this condition, and are 
hopeful and courageous from the first. It should be remem- 
bered that forebodings and despondency have no basis of fact 
whatever, but are simply manifestations of the physical con- 
dition of the patient. They should be disregarded by her, 
her mind occupied as pleasantly and constantly as possible, and 
she should train herself to look forward to the termination of 
this trial with anticipations not of disaster, but of great hap- 
piness subsequently. Those about her should be careful to 
encourage her in this belief, and especially nurses, and women 
who have already had children, with whom she may come in 
contact, should forbear from relating accounts of dangers and 
complicated cases which they have seen or experienced. Such 
is the heartless idiocy of gossips, whether professional or other- 
wise, that they seem never happy unless relating some chapter 
of horrors in which they imagine that they have been heroines. 
When we pause to consider, however, that these stories are 
always exaggerated for the purpose of magnifying their own 
exploits, we readily see on what slight basis of truth most of 
them rest. The professional nurse who knows no better than 
to alarm pregnant women with tales of dreadful confinements 
should not receive a second engagement from any one. 

Occasional peculiarities in temper and temperament, not 
usually characteristic of the patient, should be kindly ascribed 



BATHING— CARE OF NERVOUS SYSTEM. 35 

by her friends to her changed condition, and treated as purely 
physical and transient, with the greatest kindness. The patient 
herself and her friends should remember that the condition of 
her mind and her nervous system has an important bearing 
upon that of her unborn child. Intelligent women have fre- 
quently surrounded themselves during this period with all that 
was lofty, beautiful, and pleasing. It was the custom among 
the Greeks to take especial pains that nothing should be pre- 
sented to the view of such women except the most beautiful 
scenery and the most artistic forms. The aid of music and 
recitations from the poets were also invoked that the child's 
brain might be tuned, as it were, while still in process of con- 
struction, for that which was most beautiful. In modern 
times, we recall an instance of an intelligent woman leading a 
quiet life, who, during her pregnancy, chose such literature 
for her reading and such associations as she judged most likely 
to develop pure and good tastes in her child, and the result 
full}' justified her precautions. 

It is commonly supposed that the sight of a dreadful object, 
the receipt of sudden and dreadful news, great and horrible 
danger, the witnessing of a crime, or any great shock, often 
result in some permanent deformity or malformation in the 
child. There is certainly a basis of truth for this belief suffi- 
cient to cause a woman in this condition to carefully a^oid 
anything which is dangerous or terrifying. There can be no 
doubt that the mother's previous habits and also those during 
her pregnancy have a decided influence upon the formation of 
those of her child. The responsibility devolving upon parents 
can be readily appreciated on consideration of this fact. So 
far as the formation of a healthy brain and nervous system of 
the child go, regularity in habits upon the part of the mother, 
and the avoidance of exciting and endangering causes, with 
abstinence from stimulants, — in fact, a life as tranquil and 
happy as possible during these nine months, — can hardly fail 
to give the child the best possible chance for healthy develop- 
ment. 



36 MOTHER AND CHILD. 



CHAPTEE XII. 

CONSTIPATION. 

The most common trouble from which patients suffer during 
this period is that of constipation. This is generally worse 
during the first few months, and during the last six or eight 
weeks. It is to be remedied so far as possible by a carefully- 
arranged diet in which whole wheat flour, fresh vegetables, 
fruits, and a free supply of water form a large part. Consti- 
pation is especially dangerous in pregnancy, and the greatest 
pains must be taken to avoid it. Drugs should be taken on 
the advice of a physician only. The simplest remedies should 
be employed as long as possible, and not abandoned hastily. 
Thus, a regular habit in this matter is of the greatest impor- 
tance. A glass of cold water, or of hot water, taken in the 
morning as soon as the patient rises, a small glass of one of 
the mineral waters, the gluten suppositories furnished by most 
druggists, or, if this fail, glycerin suppositories maybe em- 
ployed. Enemata will generally succeed in the failure of the 
other means which have been described, and should be com- 
posed of water only, or white castile soapsuds to which castor oil 
has been added, the whole beaten up together and administered 
while warm, and, occasionally, enemata in which the yolk of 
a raw egg and a few drops of spirits of turpentine have been 
beaten up in the soapsuds. The best time for the use of such 
an injection is usually before retiring, or soon after waking in 
the morning. 

Irritability of the bladder is also a source of great annoyance 
to pregnant women, and is frequently relieved by assuming 
the recumbent posture. It is caused by the pressure of the 
enlarged womb, which is removed by such change in the posi- 
tion. Salivation or excessive flow of saliva is occasionally a 



BREASTS— VARICOSE VEINS. 37 

great annoyance, and can hardly be treated without the advice 
of a physician. 

The care of the teeth, however, is a matter which each 
woman should look after herself. After the fourth or fifth 
month of pregnancy she should visit her dentist, no matter 
whether she have suspicions that all is not right with her 
teeth or not. Her condition frequently gives rise to some 
change in the teeth, and this should be taken in hand promptly 
before it has gone sufficiently far to cause permanent trouble. 
Certain disorders of the skin not infrequently arise, and among 
them the curious formation known as the " mask of pregnancy." 
This is a peculiar pigmentation, often of a brownish-yellow, 
forming upon the forehead and face, and usually persisting 
during this time. It is caused by a deposit of coloring matter 
similar to that which is observed in other regions of the body 
during pregnancy. As a rule, it gradually fades away after 
the birth of the child, and it is not amenable to treatment. 
Although unpleasant, it is not in the least harmful, and should 
be let alone and disregarded as far as possible. The care of 
the skin, however, is a matter of very considerable impor- 
tance. The pregnant woman, in common with others, eliminates 
from the body, through the skin, poisonous material which is 
especially dangerous in her condition. 



CHAPTEE XIII. 

HYGIENE OF PREGNANCY — BREASTS — VARICOSE VEINS. 

One of the most important matters for consideration is the 
care of the breasts. As pregnancy advances they become 
more prominent, firmer in consistence, and a deposit of color- 
ing matter takes place about the nipple. Small projecting 
bodies are also seen in the colored ring which surrounds the 
nipple, and these are small and auxiliary glands. In some rare 

4 



38 MOTHER AND' CHILD. 

cases the breasts become so turgid early in pregnancy as to 
demand the use of a supporting bandage, or of some applica- 
tions of a soothing character. The care of the nipple itself is 
of extreme importance with regard to the subsequent nursing 
of the child. It not infrequently happens that from a lock of 
development the nipple is so flat and sunken that the child 
cannot grasp it. Fissures and cracks of the nipple, occasion- 
ing much distress when the child nurses, are also frequently 
met with. 

In cases of flat and retracted nipples, persistent efforts 
should be made to draw out and develop them during the 
months of pregnancy. This can be done by the thumb and 
finger, and should never be made a painful process. Occa- 
sionally a suction pump, called a breast-pump, and to be ob- 
tained at druggists, may be employed to advantage. A healthy 
nipple should stand upon the breast much as a raspberry stands 
upon its stem, and if this relative situation be not present, the 
child may have trouble subsequently in nursing. To avoid 
cracks and painful fissures in the nipple it is better not to ap- 
ply hardening agents which make its surface more brittle and 
more apt to crack, but to use some soothing ointment instead. 
The nipple should be washed at least once daily with warm 
water and castile soap. Afterwards it should be gently 
drawn out between the thumb and finger, and anointed with 
cold cream or cocoa butter. If fissures and cracks occur, the 
attention of the physician should be immediately called to 
them, If the breasts become uncomfortably heavy during 
pregnancy, they may be supported by a breast bandage, to be 
described later. Should great turgidity, sharp pain, and some 
fever be present, inflammation of the breasts is threatened, 
and the physician should be summoned at once. Yery fre- 
quently, the use of borax-water, one tablespoonful to the pint 
or half-pint, is of great service in bathing the nipple, in pre- 
venting soreness and fissures. 

The chronic const'pation of which we have spoken, together 
with the pressure of the womb upon the intestines, not infre- 



BREASTS— VARICOSE VEINS. 



30 



quently results in the development of hemorrhoids, or in 
aggravating such as may be already present. Care should be 
taken to avoid constipation, and the physician's advice promptly 
summoned in such cases. 

Yaricose veins in the legs, and sometimes about the lower 
portion of the abdomen, may occasion great distress, and in 
the case of repeated 
pregnancy may become 
so greatly distended as 
to threaten rupture. 
They often cause great 
discomfort by reason 
of a sensation of weight 
and heaviness in the 
legs, and occasionally 
they are accompanied 
by intense itching. 

The most convenient 
and comfortable means 
of support for varicose 
veins is a bandage 
three inches wide, made 
of old, soft flannel. 
This should be applied 
in the morning before 
rising, while the patient 
is recumbent. It should 
begin at the toes and 
extend to the groin. 
Several of these band- 
ages should be pro- 
vided, and washed repeatedly, and thus a convenient and neat 
form of support is furnished. When once the knack of apply- 
ing them is acquired, they are more convenient than silk and 
rubber stockings, which are frequently used, as they can be 
varied in the tightness and looseness of application, and so 




40 MOTHER AND CHILD. 

meet the individual needs of each case better than a less easily 
adjusted support. It is well to powder the skin over the vari- 
cose vein with finely -powdered borax, or with common rice- 
powder. 

Varicose veins occasionally become excessively distended, and 
rupture causes serious hemorrhage. Should this accident 
occur, the patient should lie flat at once upon the nearest con- 
venient support. The person aiding her may take a clean 
handkerchief, fold it into a square pad about two inches or 
so, and place the pad directly over the point of rupture. A 
bandage should be taken, and the limb bandaged from the toes 
up over the pad at the point of rupture. The leg should then 
be elevated upon a pillow, and a physician summoned (Fig. 2). 
It must be remembered that a bandage or string simply tied 
about the leg above or at the point of rupture may not only 
fail to check the hemorrhage, but may cause dangerous com- 
pression of the vein, increasing the bleeding ; so the whole leg 
must be included in a compression-bandage, to be effectual. If 
a bandage is not available, an old sheet may be torn up and 
one hastily improvised. Moderate pressure may be made with 
the hand upon the folded handkerchief, at the point of rupture, 
until assistance can arrive and the leg be bandaged. 



CHAPTEE XIV. 

GENERAL HYGIENE OF PREGNANCY — CLIMATE. 

So far as the general hygiene of pregnancy is concerned, 
whatever conduces to the tranquillity and general health of 
the patient is advisable. The claims of society should give 
way entirely to the patient's condition. Such social pleasures 
as are productive of rest and diversion may be enjoyed so long 
as the point of fatigue is not reached. But no restriction of 
dress and no positive engagements should be made which 



GENERAL HYGIENE OF PREGNANCY— CLIMATE. 41 

might necessitate the patient's discomfort and cause a tax 
upon her strength. So far as society has claims they are ut- 
terly insignificant compared with the claims of the patient's 
own necessities and those of her unborn child. 

In persons who are able to vary their residence at will to 
secure the best possible climate at each season of the year, it 
may be advised that extremes of heat and cold and rigorous 
climates be carefully avoided. It would be best for the period 
of pregnancy to be passed in a temperate and equable climate 
where a large percentage of the days were fair, where extremes 
of temperature did not occur, and where severe storms were 
very infrequent. Such a climate would permit of the greatest 
amount of out-door exercise, and be the most favorable for the 
patient. This, however, is rarely obtainable in our latitude, and 
the fatigue and risk of a long journey to obtain such a climate 
might overbalance the advantages to be gained by it. How- 
ever, the modern luxuries of travel are making it more easily 
possible for frail and invalid persons to seek suitable climates, 
and hence the pregnant woman who has the necessary means 
may choose a suitable climate at will. As a general thing, 
long journeys are to be avoide 1, not only because of the danger 
of abortion caused by the jolting of railway cars and the mo- 
tion of a steamer, but on account also of the difficulty of carry- 
ing out that regular and systematic care which the patient's 
daily life demands. Amusements of various kinds often serve 
an important purpose in lessening the tedium of the patient's 
enforced retirement and in diverting her mind, and so long as 
fatigue and annoyance are avoided, they are a valuable adjunct 
in securing her well-being. 

It cannot be impressed upon the patient too strongly that 
she should consult her physician as soon as her condition is 
suspected or known. Modern obstetric science does not wait 
for complications to occur at labor, but endeavors by a careful 
scrutiny of the mother to anticipate and prevent them. It is 
possible for the physician to ascertain with comparative ease 
whether the mother is naturally shaped and developed, the 

4* 



42 MOTHER AND CHILD. 

position which her child occupies in the womb, its comparative 
vigor and development, and whether the general conditions 
favorable to a successful labor are present. Should the child 
be of excessive size in proportion to the mother ; should the 
mother be smaller than the average, or deformed, or the victim 
of a dangerous and chronic illness, it is possible to so treat her 
as to give the best possible chance for the life of her child and 
her own recovery. This must be done, however, some time 
before the termination of the ninth month of gestation, and 
hence the necessity for a careful examination of the patient 
as early as possible. Certain grave diseases which often 
threaten the pregnant woman can be detected and so treated 
as to give her child and herself the best chance for ultimate 
recovery. This preliminary examination by the physician can 
be conveniently made at the patient's house, the patient occu- 
pying a recumbent position, and does not necessarily call for 
anything painful or disagreeable. It is the physician's duty 
to make this examination, and it should be, and has been found 
to be, a source of comfort and encouragement to his patient. 



CHAPTER XY. 

NURSE AND ROOM. 



It is well to select a nurse early in this period, and to send 
the nurse as soon as possible to call upon the physician. No 
nurse should be taken in whom the physician has not confi- 
dence or who is not personally acceptable to him. The patient 
should remember that he is responsible for the nurse, and that, 
in the event of injury through her carelessness, criticism would 
fall not only upon the nurse, but also upon the physician. It 
is well to send the nurse to the physician early in the case to 
give him an opportunity to have any articles prepared for his 
patient which his methods of treatment may demand. No 



NURSE AND ROOM. 43 

two physicians conduct a confinement in exactly the same 
manner, and physicians who are attentive to details, and who 
study their patient's comfort, are constantly devising methods 
and various appliances for her well-heing. It is important for 
these reasons that doctor and nurse have an early and distinct 
understanding as to the way in which the patient is to be 
treated. The nurse should take an inventory of what the 
patient has prepared for her confinement, and the patient 
should add such articles, if needed, as are deemed necessary 
by the physician. In case of accident and premature termi- 
nation of the pregnancy, the fact that the nurse is prepared 
will be found a great comfort indeed. 

In the selection of a nurse it is well to choose one who has 
been thoroughly educated. It does not make so much differ- 
ence how many confinements she has attended, or what doctors 
she has nursed for, or who have had her previously. It is of 
the greatest importance, however, that she understand the use 
of antiseptics, and that she has been so thoroughly trained that 
she will not meddle with the case, but will carry out the doctor's 
orders. Ambitious nurses who anticipate the doctor's questions 
by giving their own opinions, who always know that everything 
is right, who do not mention the minor complications until the 
doctor asks about them, but who treat them themselves, are 
not to be chosen, nor are nurses who are so far superior to 
their profession as to be ashamed to wear the uniform of the 
school from which they come. 

In choosing a room for the patient's use during confinement, 
one which is quiet, sunny, airy, and clean should be chosen. 
It is well that no plumbing should open into the room; in 
other words, that no waste-pipe, connecting with the sewer, 
should be in the room. This, of course, would include the 
modern wash-stand and closet ; but cases have been observed 
where these conveniences were sources of disease because of 
the germs conveyed through them from the sewer. It is 
better to have a room without carpets, in which rugs can be 
employed, with but few hangings, and with no article which 



44 MOTHER AND CHILD. 

cannot be thoroughly cleaned and, if necessary, fumigated 
before the labor. An adjoining bedroom for the nurse and the 
infant is a great convenience, and will do much to favor the 
mother's repose. The furniture of the room should be com- 
fortable, but all superfluous articles should be removed. The 
bed should be a single bed, or three-quarters, not too low, and, 
preferably, not placed against the wall. It is very essential 
for the convenience of the nurse and the physician that the 
bed should be easily accessible in all directions. It should not 
have very elastic springs, although the ordinary woven wire 
mattress is not objectionable. The mattress should be of hair, 
and a liberal supply of linen and blankets should be provided. 
An experienced nurse will understand thoroughly the prepara- 
tion of a bed for confinement, and will tell her patient in ad- 
vance the articles required. It may be stated, however, that, 
in addition to the usual sheets, a half-dozen old sheets are an 
advantage; several old blankets, and two pieces of white rubber 
sheeting, one yard wide and covering the whole width of the 
bed, should be provided. 

The dress of the nurse is of importance not only as a matter 
of discipline, but also from the fact that carelessness in her 
dress may be a source of danger to her patient. The uniform 
of training schools consists of a " wash" dress, covered by a 
large apron and by linen over-sleeves, which can he frequently 
renewed. As it is essential that nothing come in contact with 
the patient, or come near her, which is not perfectly clean, it 
will readily be seen that untidy dress on the part of the nurse 
is a positive source of danger to the patient. If the nurse's 
washing is done in the house, the necessity for frequent changes 
of dresses and aprons should be kept in mind, and fulfilled as 
far as possible. The nurse's apron may contain but little 
starch to advantage, as it is thus less noisy about the patient. 
She should wear noiseless shoes; at night, felt slippers are 
useful, and during the day, slippers or pumps with over-gaiters, 
or a shoe made of some noiseless leather, as kangaroo-skin, are 
indicated. 



APPLIANCES FOR THE MOTHER. 45 



CHAPTEE XVI. 

APPLIANCES FOR THE MOTHER. 

There are a number of appliances which can be employed 
to advantage in making the mother comfortable, and in pro- 
moting her recovery. She will need a certain number of nap- 
kins for the reception of what is known as the loehial discharge. 
It has been customary to use those which were washed and 
used repeatedly, but for many reasons it is better, if possible, 
to have them so made that they can be burned as soon as they 
are soiled. Any simple ataorbent material, which the nurse 
may dip into an antiseptic solution previously and then wring- 
out and dry, will be suitable for this purpose. The cheapest 
quality of cheese-cloth sold in the shops is an excellent material. 
The absorbent substance may be enclosed between two layers 
of cheese-cloth and loosely stitched at the edges. We have 
found that a napkin may be made by taking a piece of oakum 
about three inches wide and eight or nine inches long and an 
inch thick. On each side of this is placed the cheapest quality 
of cotton batting an inch thick. The whole is then enclosed 
between the two layers of a piece of cheese-cloth twelve or 
fifteen inches long and sufficiently wide to cover them. . The 
cut edge of the cheese-cloth is closed with cheap cotton thread, 
the whole napkin is dipped in a solution of bichloride of mer- 
cury (one to two thousand) and is wrung out and dried. The 
cost of these napkins, when all the material is purchased at 
wholesale, is a cent and a quarter each. When purchased at 
retail, between two and three cents. The ordinary patient 
will need six daily for the first three or four days, and four 
afterwards for a period of ten days or two weeks. It makes 
no difference whether they are made precisely after this de- 
scription, so long as the principle is carried out of an absorbent 



46 



MOTHER AND CHILD. 



substance which can be made antiseptic, and which is cheap 
and easily destroyed. 

It is customary among most women to wear after confine- 
ment an abdominal bandage or binder. In the case of strong 
and healthy women, this is not a necessity, but ft is a means of 
comfort to all, as a rule, and as such it may be employed. The 

Fig. 3. 




Buttoned binder. 

common belief, that it has much to do with restoring the 
woman's figure to its former proportions, has not much foun- 
dation in fact. If the patient be strong and well developed, 
the abdominal muscles will regain their former firmness, and 
thus the shape of the body will be restored. There are various 
sorts of binders, the simplest being a strip of hemmed muslin 



APPLIANCES FOR THE MOTHER. 47 

about a foot wide and from twenty-four inches to a yard in 
length. Whatever form be employed, they must be so made 
that they can be frequently washed. The binder which we 
illustrate was devised originally in England, and has met with 
great acceptance in. that and other countries. This binder is 
nine and a half inches wide and a yard long. Twelve inches 
from either end is a gusset four and a half inches deep and 
four inches wide at the bottom, its widest part. The binder is 
made of two thicknesses of cloth, preferably, light canvas or 
muslin. At one end of the binder are two rows of button- 
holes, one row at the edge, seven in number, one and one-half 
inches apart, and a second row parallel to the first, one and a 
half inches distant from it. At the other end of the binder 
are three rows of linen buttons, one inch and three-quarters 
apart. At the lower edge of the binder, and midway between 
the two gussets, are two pairs of buttons to which a napkin 
may be fastened from below. The application of the binder is 
as follows : Immediately after confinement, when the abdomen 
is large, the row of buttons nearest the edge is buttoned into 
the row of button-holes also nearest the edge. As the abdomen 
becomes smaller, the rows of buttons are advanced successively 
to the rows of button-holes, and thus the length of the bandage 
may be varied to suit the needs of the case. A useful binder 
may also be prepared by putting gussets in an ordinary strip 
of hemmed muslin, and fastening the binder by pinning from 
above downward. The napkin worn by the patient should 
be pinned to the lower edge of the binder behind, and brought 
up and pinned to the lower edge of the binder in front. 

In addition to the binder, a skilful nurse may prepare pil- 
lows and cushions of various sizes, made of cotton and cheese- 
cloth, which are cheap and can be readily burned when soiled. 
They may be placed under the patient's hips, and will add to 
her comfort by aiding her to change her position in bed 
(Figs. 4 and 5). 

For use upon the breasts, a breast-binder or compression- 
bandage may be prepared as follows: 



48 



MOTHER AND CHILD. 
Fig. 4. 



y -? -if — * —a - 




APPLIANCES FOR THE MOTHER. 



49 



It is twenty-nine inches long by eight wide; three and a 
half inches from either extremity, and in the centre of the 
bandage, two holes have been cut the size of a quarter of a 
dollar, the edges of which are carefully overseamed to prevent 
the apertures from tearing out, the distance between them 
being the distance measured between the nipples. At the 
upper edge of the bandage, five inches from the end, two 
shoulder-straps are attached, two inches wide. The bandage 
is so applied that it pins over the centre of the chest between 
the breasts, the apertures giving room for the nipples, through 
which the child may nurse. The shoulder-straps come over 
the shoulders and may cross in front, or be pinned, without 
crossing, to the upper edge of the bandage after it has been 



Fig. 6. 




fastened about the body. The purpose of this bandage is to 
draw the breasts upward and inward, thus relieving the pain 
caused by engorgement. This bandage may be made of can- 
ton flannel or of firm muslin, as desired (Fig. 6). 

A plentiful supply of old, soft linen is also desirable. Besides 
the articles already described, the nurse should see that the 
patient has ready in her possession such antiseptics as the 
c d 5 



50 MOTHER AND CHILD. 

doctor may select, two ounces of the fluid extract of ergot 
brandy or whiskey, a nipple-shielJ, and be sure that an abun- 
dance of hot water can be procured conveniently and imme- 
diately, if desired, in the room which the patient will occupy. 
There should be, if possible, no question regarding the burning 
of any bandage or inexpensive appliance which becomes soiled. 
Napkins can usually be rolled in a piece of newspaper and 
burned in the kitchen range or an open fire. Old night-dresses 
should be chosen for the patient's use while in bed, as it is 
sometimes convenient to tear them down the centre in front 
instead of slipping them off in the usual way. 



CHAPTEE XYIL 

APPLIANCES FOR THE CHILD. 

For the child, the elaborate and extensive wardrobes fre- 
quently purchased are worse than useless. Money is spent 
unnecessarily in what cun hardly be, from the nature of the 
case, in good taste, and for what is often improperly made. 
The child's clothing should be warm, soft, compressing the 
body in no direction, and its weight, like the weight of its 
mother's clothing, should be supported from the shoulders. It 
has been the custom among Indians to pack the new-born 
child in moss, and some soft and warm material like moss 
would certainly represent an excellent dress for a child. The 
finest quality of flannel, or garments knit of the finest worsted, 
are usually the best. The wardrobe of the new-born child 
should consist, first, of a dressing for the umbilical cord, then 
of an abdominal band or belly-band over that; a diaper; a 
woollen or knit shirt with long sleeves, a woollen skirt, and a 
white shirt and skirt combined, over the whole. For the feet, 
worsted socks can be readily knit, which are not only most 
comfortable and suitable, but also pretty. 



APPLIANCES FOR THE CHILD. 51 

The best method of dressing the umbilical cord will be 
selected by the doctor, and will be outlined in the description 
of the conduct of labor. 

Not more than a half-dozen changes of clothing are needed 
for the child in the beginning, as its size cannot, of course, be 
known before birth. The making of its later wardrobe fur- 
nishes a most agreeable occupation for its mother and friends. 
If the baby's clothing be properly made, there need be but one 
pin employed in the whole dressing, and that a diaper-pin. 
Other garments should be fastened by strings or buttons. 
An abundance of diapers should be provided for the child, of 
cotton or limn, of such a size that when folded once they are 
less than a half-yard square ; and doubtless before many years 
some cheap, soft, and absorbent material, like Japanese paper, 
may be found which can be destroyed as soon as it has become 
soiled, thus obviating the necessity for washing. 

A description of the various babies' wardrobes devised by 
different nations would furnish an extensive catalogue of such 
articles : the pappoose of the Indian mother is familiar as a 
national relic, and her Scandinavian and German friends have 
embodied the same principle in what is known as the " child's 
mattress." This consists of a soft and thin mattress quilted 
and heavily wadded, but sufficiently large to contain the child, 
and permit of its being folded over its body. The child is 
thinly dressed, laid upon the mattress, and the mattress folded 
over it and held in place by an embroidered band about three 
inches in width, which is crossed and recrossed over the child 
diagonally. The child thus becomes virtually a little bundle, 
and can be transported with great ease (Fig. 7). Such a de- 
vice, however, is only of use during journeys, and, in the main, 
the mattress is too warm to be constant^ worn. It is some- 
times advantageous, however, either to employ something like 
the mattress if the child goes out in its carriage, or to take 
especial pains that the child's limbs and body are protected by 
a warm mattress in the bottom of the carriage, and by a thick, 
soft afghan or lap robe. 



52 MOTHER AND CHILD. 

Former generations of American children were dressed upon 
the jorinciple of low neck and short sleeves, and those who re- 
member this usage will assert in support of it that children so 
dressed were certainly as robust and well developed as any at 
the present day. While that may be true, experience proves 
that to-day the best clothing for the infant child is woollen or 
silk of various grades of thicknesses, covering the entire body. 
Thus, an exceptionally fine and robust infant has been dressed 
in a silk undershirt and two petticoats sewed upon one waist or 
body, the whole so arranged that the child is dressed practi- 
cally simultaneously. 

Fig. 7. 




During the heated term it is .especially desirable that the 
infant live as much in the open air as possible, and that the 
surface of its body be protected from sudden changes of tem- 
perature, from moisture, and from draughts. This is best 
accomplished by removing all superfluous wraps and coverings, 
and dressing the child from neck to heels in the lightest and 
finest flannel. The difference in the customs of heating dwell- 
ings has also necessitated some difference in the clothing of 
children. The house clothing of the child must be propor- 
tionately much lighter than the clothing which it wears out 
of doors, because the average house is overheated, and the 
change is thereby greatly exaggerated from the air in-doors to 
the out-door atmosphere. 

The ordinary baby's cap, which covers the back of the head 
and the ears, is wisely planned, for the infant child has thus 
portions of the head carefully protected which are easily 
injured. It must be remembered also that the infant's eyes 



CHILD'S CRADLE AND BASKET. 53 

are extremely sensitive, and hence its face should be shielded 
from the light by a veil or some suitable covering. The igno- 
rance and stupidity of the average child's maid who takes the 
baby upon the street in a carriage, its face upturned and 
frequently exposed to bright sunshine while she gossips with 
some other servant or with the traditional park policeman, 
cannot fail to result in some injury to the infant's sight. 



CHAPTER XVIII. 

child's cradle and basket. 

The cradle or sleeping-place of the child has been made 
the centre of most of the poetry of infancy. Whether the 
baby be rocked on the tree-top, carried on the back of its 
mother, or rolled up in a bundle with other baggage, it is still 
cradled in some fashion or other, even when lying upon her 
arm in bed. It is needless to say that from the day of birth 
the infant is entitled to its own separate, undisturbed sleeping- 
place. It should not sleep with the mother, it should not be 
rocked and jolted while asleep, and if it is expected to become 
a rational and thinking person, it should be accorded those 
opportunities for undisturbed repose which are necessary to 
the nourishment of any normal brain. Despite the desire of 
mothers to keep the child with them, of grandmothers and 
nurses to trot the baby and sing the baby to sleep, it is 
far better that the child, soon after its birth, should be taken 
to its place of sleep, placed comfortably upon a suitable bed, 
properly covered, and left entirely alone. Such is the un- 
thinking zeal of many nurses and friends of mothers that 
such an education for the child is possible only among the 
most intelligent people, in whom reason predominates over 
tradition and prejudice. The objections to placing the child 
in bed with the mother, among people of the better class, are 



54 MOTHER AND CHILD. 

that the child inspires the air contaminated by the mother's 
secretions and excretions ; that the constant tendency is for 
the child to nurse too frequently, and that the repose of the 
mother and child is mutually disturbed. Among people of the 
poorer class and among the vicious, carelessness, excessive 
fatigue, and drunkenness on the part of the mother result in a 
considerable mortality among infants from what is known as 
overlaying. Owing to the mothers carelessness, or during the 
profound sleep of exhaustion or drunkenness, the child slips 
down beneath the mother's side, she rolls over upon it, and it 
dies from pressure and asphyxia. If the mother is without 
assistance, she may place the infant alongside of her bed in 
any suitable receptacle, but not in the bed with herself. We 
recently visited a happy mother, fertile in expedients, not rich 
in this world's goods, but rich in the possession of a fine baby, 
who took a clean, dry wash-tub, filled it full of blankets, and 
placed her baby in it upon a pillow. The baby slept peacefully 
beside the mother, and both were happy and contented. Ordi- 
narily, a solidly-built crib without rockers will be found most 
convenient and advantageous. This, of course, should be sur- 
rounded by sides sufficiently high to obviate any danger of 
the child's falling out. The mattress should be moderately 
firm, the child's pillow low, and when put to sleep, the child 
should be carefully guarded from the light. 

The contents of the bassinet (or baby-basket) should consist 
of the baby's toilet articles : simple rice powder, a little pot of 
white vaseline or cold cream, white Castile or spermaceti soap, 
and such other articles as an experienced nurse or mother may 
deem necessary. Appended is a list of an outfit which has 
been found of practical use : brush and comb, skein of white 
twisted embroidery silk, soft, fine sponge, bottle of white vase- 
line, sharp pair of pointed scissors, powder-box and puff, with 
talc powder; pin-cushion, small and large safety-pins, pure 
Castile soap, pair of socks, some old, fine linen, flannel or 
knitted band, flannel shirt, a petticoat and night-gown for in- 
fant ; an afghan or piece of extra flannel, in which to wrap the 



CHILD'S CRADLE AND BASKET. 55 

child ; also piece of flannel, or old blanket, to receive it in ; in 
addition, the baby will require eight day-dresses, eight night- 
gowns, eight white skirts, four day-flannel skirts, four night- 
flannel skirts, four pairs of day-socks, four pairs of night-socks, 
six flannel shirts, six flannel bands, three dozen small, soft, linen 
diapers, three dozen larger, cotton ones, at least two little 
knitted sacks. 

The following description of a crocheted baby-band is taken 
from " Babyhood," vol. iii. page 33 : Single zephyr in ridge 
stitch, — that is, half stitch, in which, going back and forth, only 
the back half of the stitches in the lower row are picked up. 
Eegin on a chain of fifty and crochet forty-eight ridges, hence 
ninety-six rows, Join by a row of plain stitches, and at top 
by a picot edging (five chains and a tight stitch back into the 
first). 

To prevent chafing and excoriation of the infant skin, many 
mothers employ some favorite dusting-powder, and others who 
are very fond of the perfume of violet, have used powdered 
orris-root, and, as we have had occasion to remark, some of the 
finest babies we have ever seen were not powdered at all, but 
anointed with simple ointment. It is of 
the greatest importance that the mother Fig. 8. 

prepare not only the clothing for the child 
and articles intended for herself, but also 
that she prepare herself to nurse the 
child. We have described the care of 
the nipple, and this should be persistently 
kept up until the day of confinement. A 
nipple-shield (Fig. 8) should be included 
in her outfit, and if there has been trouble 
in drawing out the nipple, the simplest 
form of breast-pump should also be at Nipple- shield. 

hand. Unless she be the victim of some 

infection, she should have no other idea but that of nursing 
the child. She will remember that while a substance resem- 
bling milk may be present in the breast for some months prior 




56 MOTHER AND CHILD. 

to the birth of the child, yet the formation of fully-formed 
milk will not take place until several days after confinement, 
and that fully-established lactation is a portion of the process 
of childbirth. 



CHAPTEE XIX. 

LABOR. 

A brief description of what is meant by normal labor may 
be of service to the patient in understanding the preparations 
to be made for it and the care to be given her during that 
time. Labor may be divided into three stages or divisions. 
The first of these is the period occupied in the gradual open- 
ing of the womb, and is a preparatory stage to the expulsion 
of the child. This stage lasts in first confinements a number 
of hours, varying greatly with the individual case. It is, as a 
rule, shorter in repeated confinements, and also attended with 
less pain. The pain which is present during this stage is gen- 
erally characterized as grinding, or bearing down, oftentimes 
commencing in the back and extending downward over the 
abdomen. It is most annoying and difficult to endure, as the 
patient cannot appreciate that progress is making, and realizes 
only what seems to be useless suffering. 

When, however, the womb is open, ready for the expulsion 
of the child, the membranes in which the child is contained 
rupture, there is an escape of fluid, and the birth of the child 
begins. This is a comparatively short interval in normal cases, 
compared with the first stage, and is usually completed under 
the care of a physician, and oftentimes w T ith the use of anaes- 
thetics. After the birth of the child, the after-birth or placenta 
still remains, and is expelled after a brief interval resembling 
the first period. 

It is of especial interest to know the symptoms which indi- 
cate that labor has actually begun. For some days before, the 



LABOR. 57 

patient frequently suffers from pain in the back and in the 
thighs, from a feeling of weight or heaviness about the lower 
portion of the body, and is often extremely uncomfortable. 
These pains may be worse at night, and become so severe that 
the physician may be sent for, under the impression that birth 
has actually commenced. Subsequently, however, such pains 
die away, and there is a gradual return to a condition of com- 
parative comfort. There is this difference between so-called 
false and true labor pains, that the false or fugitive pains are 
irregular, coming and then going, and diminishing instead of 
increasing in intensity, while true pains at the beginning of 
labor grow steadily stronger, and are located more and more 
in the abdomen. This will enable the patient to distinguish 
between these two classes of pains. 

During the first stage of labor, all that can be done for the 
patient is to place her in the most comfortable position pos- 
sible, to sustain her strength, and to assist her to have patience 
until the more active progress of labor begins. It is best for 
her not to lie down at once in first labor, but to continue in 
the erect or semi-erect position, walking about the room, sit- 
ting, standing, or kneeling, as may be most comforting to her- 
self. If the nurse be present, she will look after certain mat- 
ters of importance at this stage. If the woman be without 
a nurse, she will do well to see that everything is in readiness, 
and also, if possible, to secure a movement of the bowels, and 
to see that water is passed freely. In women in repeated labors, 
who have borne many children, the first stage may be so short 
that the patient has to lie down at once, and if her labor come 
on suddenly when she is alone, it is not safe for her to continue 
upon her feet, as the danger is that the labor will be too rapid 
for the mother, and the child be injured (Fig. 9). She should 
lie down at once, preferably upon her left side, and remain as 
quietly as possible until assistance arrives. 

The second and third stages of labor are almost invariably 
conducted by some competent physician, but occasionally it 
happens, especially in strong and healthy women who have 



58 



MOTHER AND CHILD. 



borne children repeatedly, that labor may be' completed so 
quickly that assistance does not arrive until all is over. A 
neighbor or friend can always be summoned, and with such 
assistance — so perfect are the provisions of nature — it is quite 
possible for a woman to have a perfectly successful labor with- 
out skilled service. It is well for whoever is with her to see 



Fig. 9. 




Patient's Bed, prepared for Labor.— a, folded sheet; b, c, sheet and rubber 
sheet, which are removed with a, when soiled during labor; d, clean sheet, on 
which patient lies after labor. 

that during the birth of the child she lies upon the left side, 
with the thighs bent up towards the abdomen. The person 
who helps her should wash her hands carefully, and as the 
head of the child is born should endeavor to support it, press- 
ing it gently upward between the thighs towards the mother's 
abdomen. When the child is born, the cord should be grasped 
between the thumb and finger, when it will be felt to pul- 
sate, and when this beating ceases, it should be tied firmly 
with a bit of strong thread, three fingers'-breadth from the 
child's navel. It should be tied a second time, half an inch 
nearer the mother than the first tie, and cut between the two 
threads. The mother should then be kept perfectly quiet 
while her helper may place her hand over the abdomen and 
make gentle pressure. After a few moments, pains resembling 



LABOR. 



59 



those experienced during the birth of the child will return, 
and the after-birth will be expelled. The assistant should be 
very careful that she does not break the afier-birth, but as she 
lifts it away it should be received very carefully in both hands 
and removed. The. patient can then be bathed with warm 
water and soap and left quietly in bed, a clean towel and 
folded sheet (Fig. 10) having been placed beneath her. 

Should flooding come on after the birth of the child, the pa- 
tient's assistant should place the hand upon the abdomen and 
rub it gently but rapidly. She will then feel the enlarged womb 

Fig. 10. 




Bed after Labor,— soiled linen removed and patient's bandage and napkin 
ready for use.— a, 6, napkin ; c, binder. 



like a hard ball, the size of the baby's head, just beneath her 
hand. So long as thi3 ball remains hard, there is not much dan- 
ger of severe bleeding. When it becomes large and soft, then 
the rubbing should be repeated until contraction recurs. These 
simple directions may prove of value in case a physician or 
experienced nurse cannot be obtained, but it must be distinctly 
understood that the conduct of labor is a matter requiring the 
greatest skill and wisdom, and should never be undertaken 
without the supervision of an intelligent physician. Even if 
the labor have proceeded normally without assistance, a doctor 



60 MOTHER AND CHILD. 

should be summoned as soon as possible, and should be asked 
to examine the patient thoroughly, as some injury may have 
happened, or some complication resulted which makes his ser- 
vices of the greatest importance, even although the child has 
been born. 

But returning to the care of the patient during her labor 
when she has the advantage of the assistance of a physician 
and nurse, it must be remembered that the process is one which 
taxes her strength severely, and that she needs all which can 
support and sustain. While a large quantity of food cannot 
be advantageously taken at any one time, yet nourishment in 
the form of broth, milk, egg beaten up with wine, cocoa, and 
any easily-digested article of food is much needed if the case 
be prolonged. Occasionally, stimulation is required, but that 
should be limited to tea or coffee, except by the doctor's orders. 
There. is danger of the patient taking cold if care be not exer- 
cised to keep her room warm enough, and to look carefully after 
her clothing. The directions which have been given already 
to the patient without assistance, will be carried out, of 
course, by the nurse. 



CHAPTER XX. 

PUERPERAL FEVER. 

The care of the patient during the latter part of labor, and 
afterwards, cannot be intelligently understood unless something 
be said regarding what is meant by blood-poisoning, puerperal 
fever, and antisepsis. It is within the present century that 
the two prominent teachers of obstetrics in the city of Phila- 
delphia declared that puerperal fever was in no way caused by 
the physician or nurse, but was entirely beyond their control. 
Puerperal fever, they taught, occurred as typhoid, malaria, 
rheumatism, and other diseases which were not contagious, 



PUERPERAL FEVER. 61 

but depended upon some unknown condition of the atmos- 
phere or the influence of the soil for their existence. Mean- 
while, in Austria, the discovery had been made that puerperal 
fever generally resulted when the physician had been dissect- 
ing or making a post-mortem examination, and then immedi- 
ately attended an obstetric case. When disinfectants were 
used by such a physician, and especially when his hands were 
carefully scrubbed and then disinfected, his patients escaped 
puerperal fever. One of the brightest honors of the many 
which Oliver Wendell Holmes has won is the fact that at this 
time, and while he stood practically alone in the American 
profession in his opinions upon this point, he answered in a 
most trenchant article the teachings of the Philadelphia pro- 
fessors to whom allusion has been made, proving that they 
were wrong, and asserting positively that the Austrian discov- 
eries were correct, and that puerperal fever was contagious, 
or, according to a popular phrase, " catching." We think com- 
monty of Dr. Holmes as a poet, a wit, a literary man, but the 
services which he rendered in urging the truth regarding this 
matter upon the profession in his country, and the number 
of lives which have been saved by the knowledge of the true 
nature of puerperal fever, can never be appreciated. 

At the present day, we know positively, as far as any knowl- 
edge is obtainable by human beings, that puerperal fever is 
caused by a living ferment, and that in the vast majority of 
cases some one who touches the patient, usually the doctor or 
nurse, gives her puerperal fever. It is at once apparent that 
certain strenuous precautions are imperative upon those who 
attend such patients. Clean hands, clean instruments and ap- 
pliances, clean bedding about the patient, scrupulous cleanliness 
regarding herself, and, as an additional safeguard, the use of 
certain chemicals to cleanse the hands, instruments, and appli- 
ances which touch her, are what every woman has a right to 
demand in the present state of our knowledge. This recent 
knowledge should be of the greatest comfort and advantage to 
the woman who is about to become a mother. She has the 

6 



62 MOTHER AND CHILD. 

satisfaction of knowing that the most dreaded complication of 
maternity has been reduced to a minimum, and that where such 
intelligent care is given, her chances for safety and a good re- 
covery and the safety of her child are many times greater than 
in the last century. The fearful epidemics which at times de- 
stroyed large numbers of women are unknown in the practice of 
intelligent men. There still remain a number of physicians and 
nurses who have not informed themselves regarding the causes 
and prevention of puerperal fever, who do not know how to 
recognize some forms of this disease when they arise, and who 
cast doubts upon our knowledge regarding its origin and pre- 
vention. Such objections, however, are no more to be consid- 
ered in the discharge of duty towards patients or friends than 
are the theories of those who dispute the utility of vaccination 
or the fact that typhoid fever is caused by impure drinking- 
water. 

The living germs which cause puerperal fever have their 
most common production in the decomposition of the tissues 
or fluids of some animal. Hence it is extremely dangerous 
when the after-birth is not expelled, but remains in the womb, 
where it is liable to decompose. After it has been expelled 
it should be destroyed, if possible, by fire, or buried with lime. 
The lochial discharge is also liable to decompose, and hence 
the necessity for frequently changing the napkins used to re- 
ceive it, and for employing such napkins as have been pre- 
pared by antiseptics. Antiseptics are certain substances which 
have the property of destroying these living germs. Such 
are corrosive sublimate (bichloride of mercury) and carbolic 
acid. One of these is usually employed as an antiseptic or fer- 
ment-killer in caring for the patient during and after labor. The 
hands of the physician and nurse, as well as all instruments and 
appliances used, should be not only cleansed but also rendered 
free from ferments by the action of one of these substances, 
or heat. We know that equally powerful with chemical anti- 
septics is the action of a high degree of heat; hence a piece of 
cloth which has been thoroughly boiled cannot contain poison- 



FIRST FEW DAYS AFTER CONFINEMENT. 63 

ous germs, and so it is comparatively easy to render clothing 
and bedding safe for use ; but the hands cannot be boiled, and 
there are certain appliances and instruments which are also 
damaged by heat, and so it is necessary not only to employ 
heat, but to make use of chemical antiseptics. The reason why 
we have urged that the napkins be burned and not used again 
is because they may not be thoroughly cleansed in washing, 
and when used a second time may retain decomposing material 
which is easily absorbed by the patient, causing puerperal 
fever, or blood-poisoning. We have taken the liberty of intro- 
ducing what may seem to be a purely scientific discussion as 
to the nature of puerperal fever, but we know from experience 
that the average woman of intelligence is not willing to accept 
a certain routine because her grandmother was cared for in 
that way, but that she is fully aware of the advance made by 
modern science in a general way, desires to profit by it, and is 
ready and anxious to co-operate with any sensible physician 
who will do her the justice which her intelligence deserves. 



CHAPTEE XXL 

FIRST FEW DAYS AFTER CONFINEMENT. 

The mother's first needs, after labor, will naturally be rest 
and quiet. It very often happens that the excessive exer- 
tion of labor and the perspiration which frequently accompa- 
nies it render the patient especially susceptible to cold, and 
hence the contact of the air after labor very often results in a 
slight chill. This is partly owing, also, to the nervous exhaus- 
tion and prostration from which the patient naturally suffers. 
It is of no importance, and should be treated by placing an 
extra blanket over the patient, or by giving a cup of hot tea, 
or some other acceptable hot drink. Jt cannot be too strongly 
insisted that the mother's greatest needs after confinement are 



64 MOTHER AND CHILD. 

rest and quiet. The congratulations of friends, the idle curi- 
osity of those who are ready to intrude into a sick-room, should 
be warded off from the patient, and having been assured by 
the evidence of her own sight and touch that her child is living 
and safe, she should be given some slight nourishment or stim- 
ulant, as a cup of broth or of tea, or a glass of milk, and then 
allowed to go quietly to sleep. One of the great uses of the 
trained nurse in the sick-room is the somewhat disagreeable 
but necessary function of police, and in proportion as she is 
allowed to control the patient, in that proportion can the physi- 
cian's orders be intelligently carried out. In healthy women, 
a refreshing slumber of from two to four hours will follow 
delivery. This period gives the nurse ample opportunity to 
wash and dress the baby, and affords the child also an occasion 
for obtaining sleep. 

The mother's diet is not subject to the fear which formerly 
existed, that generous food produced puerperal fever or inflam- 
mations of some sort. It is the kind of food and the intervals 
at which it is given which occasion distress, and not the fact 
that the food is nutritious or abundant. For the first three or 
four days the most easily digested food is indicated; milk, 
broth, soups, milk-toast, soft-boiled eggs, koumiss, cocoa, and 
stewed fruits should be employed, the intervals of feeding 
being governed somewhat by the mother's desires. Nourish- 
ment, however, should be taken from four to six times in the 
twenty-four hours during the first three or four days. After 
this period, an abundant but easily -digested diet may be allowed, 
embracing any articles which agree with the patient. The old 
fear that acids and salads could not be taken is erroneous, as the 
acid is digested in the body, and the practical test of any article 
is not whether it is an acid or not, but whether it agrees or dis- 
agrees with the patient. Whatever agrees with her makes good 
milk for her child. The patient should be fed abundantly, and 
food may be taken in small quantities, if it be easily digested, 
as often as four or six times a day, although the mother may 
be up and about and able to resume her household duties. 



FIRST FEW DAYS AFTER CONFINEMENT. 65 

After the third or fourth day, as we have already remarked, 
the patient's diet may be governed by her appetite. Certain 
sorts of food have been recommended as especially adapted to 
produce a now of healthy milk. Extract of malt tan be taken 
by many mothers with advantage. Young and tender sugar 
beets, it is said, may be eaten ; beer and porter seem, in some 
cases, to take a place which nothing else will fill. Milk as 
a beverage, foods made of milk, and cocoa are often suffi- 
cient; but the general principle that that which is best digested 
and the most thoroughly enjoyed is the best food \ery rarely 
leads us astray. So small a thing as the use of water as a 
beverage is sometimes overlooked in caring for such patients. 
At the third or fourth day the physician will usually prescribe 
a thorough laxative. After this time, the bowels should be 
moved by the simplest and mildest measures ; an injection of 
castor oil and soapsuds beaten up together and warmed, or of 
simple salt and water, the use of a gluten suppository, or a 
glycerin suppository, will generally be sufficient. Compound 
licorice powder, sold by druggists, will agree well with many 
patients, and some preparation of cascara sagrada is often effi- 
cient. It should be remembered that a dose of any laxative 
medicine which failed to produce an effect during pregnancy 
will often be sufficient to purge a patient violently after labor. 
Thus we recall a case where a woman who had taken very 
active cathartics during pregnancy urged her physician to give 
her a " strong pill," as she expressed it, the fourth day after 
labor. He could not yield to her request, but prescribed simple 
doses of licorice powder, which acted far too energetically 
for the patient's comfort. This difference is caused by the fact, 
already mentioned, that the enlarged womb, before confine- 
ment, presses upon the intestines, preventing their emptying. 
When the womb is emptied, after the delivery of the child, 
there is no obstruction then to movements of the bowels. 
The womb grows smaller after the expulsion of the child by 
process of contraction, which causes pain similar to that experi 
enced during labor. These are called afier-pains, and after the 
e 6* 



6Q MOTHER AND CHILD. 

birth of the second or third child are frequently so severe 
as to keep the patient awake at night. A warm cloth or 
fomentation over the abdomen will often relieve them, and if 
not, a physician's prescription must be obtained. 

The diet of a mother after childbirth usually consists of 
ordinary sick-diet. The object of keeping a woman on diet of 
this kind is simply because she is in bed, her digestive system 
is rather weakened by the excessive strain, mental and other- 
wise, which she has gone through, with fatigue, and liquid 
nourishment can be given which is more readily digested and 
quickly absorbed than solid food. 

Doctors simply differ in their advice because patients differ 
in regard to their digestion. Sometimes a woman is ordered a 
mutton-chop, a bowl of thick gruel, or some milk-toast imme- 
diately after a confinement ; others, again, are allowed to get 
up before the ninth day. 

The family physician knows the peculiarities of his case, 
and is capable of judging what is best for his patient. Strong, 
healthy women can do many things that the frail and delicate 
cannot attempt. 

As the supply of milk contains so large a quantity of water 
(almost ninety parts in a hundred), a great deal of the food 
which the mother takes should be liquid to supply this demand. 
If a mother loses her baby in childbirth, and it is necessary to 
check the flow of milk, not only is it necessary to put bella- 
donna plasters on the breasts, but also to diminish the amount 
of fluid taken. 

If she wishes to increase the flow of milk, she should drink 
freely of milk, soups, water, and may also rub the breasts with 
some castor oil. it is probable that in this way the use of 
alcoholic stimulants, as beer and porter in large amounts, 
became fashionable for the purpose of increasing the milk- 
supply. 

Though excellent at times for delicate, worn-out women, we 
certainly would oppose their universal use. Alcohol rather 
lessens the milk-flow. 



FIRST FEW DAYS AFTER CONFINEMENT. 67 

The preparations of malt are far more valuable, as they in- 
crease the appetite and aid digestion. 

There being a determination, of blood to the mammary 
glands during the secretion of milk, many substances may be 
carried along with it that should be thrown off in other ways ; 
thus, medicines are often secreted by the milk, and affect the 
child, that are intended to have a purgative action on the 
mother; a dose of castor oil will act sometimes in this way. 
Articles of diet also affect milk. 

We are all familiar with the garlic taste given to milk and 
retained in the butter, from cows turned out to grass in the 
spring-time. And, indeed, cases have occurred of acute poi- 
soning by milk from cows that have eaten largely of poisonous 
herbs in the pasture-field. 

Although a mixed diet, containing a free supply of vegetable 
food, also of animal food, of the cereals, together with a proper 
amount of fluid, is important for every nursing mother, there 
are certain times when additions should be made to one of 
these divisions of food to supply a demand ; thus, if a child is 
emaciating, does not seem to increase in weight, the free use 
of fats by the mother, as cod-liver oil, will soon be followed by 
an improvement in the health of her babe. If there is a ten- 
dency to rickets, the mother should eat more largely of prep- 
arations containing lime, such as oatmeal, cracked wheat, or 
even take lime itself. 

A woman who is fat and well nourished may have the poor- 
est kind of milk for her baby ; all the nourishment goes to 
herself, the milk probably being of a very thin, watery kind. 
Indeed, in the choice of a wet-nurse, it is often found that 
the lean but healthy woman gives the most and the best 
milk. 

Constipation resulting from torpidity of the liver, or over- 
feeding, will frequently affect the milk and cause it to disagree 
with the child. Not alone is milk altered in its nourishing 
qualities, or in its digestibility, by materials not belonging to 
it or entering into its composition, but we very frequently have 



68 MOTHER AND CHILD. 

indigestion produced by milk«which has probably been changed 
in its characteristics by emotion, by strong nervous impressions 
due to worriment, fright, or the fatigues of society ; certainly, 
late dinner-parties, both from the character of the food and 
the late hour, would not be conducive to the production of 
nourishing milk. 

We have stated that regularity is the fundamental law to be 
observed by the nursing mother. 

DIET. 

The diet of the cursing woman should always be carefully 
regulated, for upon it greatly depends the amount and charac- 
ter of her milk. It is impossible to lay down any laws in 
regard to the kind of food she should have. 

Every sensible person knows what agrees with her and what 
does not ; little indiscretions may be pardoned when she alone 
has to suffer, but when indigestion means an infant with indi- 
gestion also, greater care should be observed. It is not the 
amount of food one takes, but the quantity one digests that 
should regulate the diet. 

Some people manage to live on much less than others be- 
cause the waste is less. A too generous meat diet, rich milk, 
cheese, and wines or beer will give the liver a heavy load to 
carry, and so-called biliousness will result. 

Therefore, a nursing woman should avoid this extreme. 
A too liberal diet of farinaceous food, potatoes, hot breads, oat- 
meal, etc., will produce flatulence and heart-burn. 

The diet, therefore, should be a mixed one, suited to the indi- 
vidual, to'the climate, to the amount of exercise she takes, and 
to her hereditary tendencies. A moderately rich milk, well- 
steamed rice, rare and juicy meats, tender fowls and game with 
fruits, light farinaceous and egg-puddings, well-made gruels, 
eggs, oysters, and fresh vegetables form the best dietary. 

But all fried dishes should be avoided. Her food should be 
most plentiful, palatable, of the most nourishing quality, and 
frequently taken. 



FIRST FEW DAYS AFTER CONFINEMENT. 69 

Bread, butter, and milk should be used in large amounts. A 
cup of hot coffee or chocolate in the morning, hefore rising ; 
a substantial breakfast; the heaviest meal in the middle of the 
day; a light tea in the evening, with a bowl of gruel, such as 
oatmeal, the last thing upon retiring; a glass of milk just 
before or after each nursing, and possibly, if the patient feels 
much exhausted, malt extract will be of service. 

It is absolutely essential that the nursing woman should 
keep her bowels regular. The skin, kidneys, and bowels throw 
off poisonous matters, which, if not gotten rid of in the natural 
way, will find themselves in the milk. 

The organs of the body work as a co-operative association, 
and have a remarkable way of aiding one another. Should 
one organ become lazy or diseased, another will take its place. 
In this way the milk-glands, regardless of the welfare of the 
babe, will aid the kidneys, skin, or bowels. 

Much is written on the subject of water-drinking. Some are 
very decided in opposition to water at meals, others to water 
between meals, others to water at any time. Water is the 
great solvent for all those substances which are properly called 
the ashes of the economy. The main ingredient of all the 
secretions and excretions of the body is water. The water 
should be pure, fresh, and not iced, and a fair amount should 
be taken with each meal. 

Large amounts at meals will weaken the gastric juice and 
undoubtedly cause dyspepsia. But difficulty will just as readily 
attend the digestion of a meal which has not sufficient liquid 
with it to promote the secretion of the gastric juice. 

A glass of water the last thing at night, or upon rising a 
glass of warm milk or a cup of cafe au lait, a glass of water with 
a pinch of table salt before breakfast, will frequently overcome 
the most obstinate constipation if persevered with. It is neces- 
sary that the bowels should be daily moved; this may be 
accomplished by a free vegetable diet, the moderate use of 
fruits, exercise in the open air, and an occasional enema, if re- 
quired. 



70 MOTHER AND CHILD. 

The use of purgatives should be confined to eascara cordial, 
compound licorice powder, a teaspoon ful at night, Husband's 
magnesia, or effervescing citrate. 

Great care should be taken by the mother that she does not 
take cold. It is well to have always a light shawl to throw 
over her while nursing her baby. 



tJHAPTEE XXII. 



MOTHER S RECOVERY. 



After lactation has become well established at the fourth or 
fifth day, the mother usually enters upon one of the most com- 
fortable periods of her physical existence. For the time being 
she is, in a large measure, free from the anxieties and cares of 
dail}' life ; the apprehension which she may have felt regarding 
the termination of her labor has given place to the joy and 
affection of maternity. If she is properly cared for, and is a 
healthy woman, she is generally extremely comfortable. The 
fatigue and soreness which follow labor have disappeared, her 
appetite rapidly returns, and is generally better than for weeks 
before her confinement. The companionship and care which 
she gives to her infant are a source of endless delight, and the 
affectionate solicitude of friends and relatives makes her the 
centre of all which is in the highest degree charming. It 
should be remembered, however, that while this period is one 
of repose, it is a time of the greatest activity in her physical 
organism. The balance between various functions of the body, 
which has been disturbed by the presence of the child in the 
womb, has been restored; the mother's blood, which was im- 
poverished by the nourishment given to the child, begins to 
make good its losses; disturbances of the nervous system and 
mental depression have passed away, and in many cases a new 
era of physical development begins. The womb, which has 



MOTHER'S RECOVERY. 71 

been enlarged many times its usual size to contain the child, 
undergoes a process of becoming smaller, the successful com- 
pletion of which is of the greatest importance to the woman. 
The muscles of the abdomen, which have been stretched by 
the womb and its contents, must regain their former firmness 
and elasticity; this necessitates not only increased nutrition, 
but also increased absorption of portions of the enlarged womb. 
Hence it is that not only must the mother be fed, but those 
functions of the body which tend to remove material already 
used should be kept in full activity. The action of the skin 
should be maintained by daily bathing and massage ; the 
bowels, which generally have become distended through the 
pressure of the enlarged womb, should be thoroughly and 
regularly emptied. Sufficient fluid should be taken to assist 
the kidneys in their work, while fresh air in abundance should 
be given to the patient to replace the gases exhaled through 
the lungs. 

Sleep, the greatest promoter of nutrition, should be taken in 
abundance and with regularity, while the development and 
restoration of muscles over- distended or weak from lack of 
use may be encouraged by systematic massage. The patient 
must not exercise or assume the upright position for at least 
two weeks after the birth of her child, but passive exercise 
may be given by skilful massage after the first week of her 
lying-in period. This massage should begin with the arms 
and legs, the muscles being gently kneaded and the joints 
gently manipulated. The back may next be included, and 
gentle rubbing without severe kneading given to the chest and 
abdomen. This should be administered for fifteen minutes at 
first, increasing gradually until, at the third or fourth week after 
the birth of the child, the patient may enjoy three-quarters of 
an hour or even an hour of such treatment. 

Possibly no more important crisis occurs in the mother's life 
than her getting up after confinement. There are various 
well-settled traditions which govern the actions of the majority 
of women ; one is that the mothers nurse should remain in 



72 MOTHER AND CHILD. 

all four weeks, hence the term " monthly nurse." Another 
belief is that at the tenth day, or after, the mother should sit 
up. Both traditions are the result of experience and observa- 
tion of a vast number of cases of confinement, but neither has 
the slightest value as a guide in any given single case. It would 
be just as rational to say that because one mother is fond of a 
certain article of diet, and does well on it while nursing her 
child, that therefore every mother should eat exactly that 
amount, and be expected to enjoy it, as it is to say that every 
mother needs the same repose after confinement. It is a ques- 
tion for the physician, and for him only, to decide. It makes 
no difference what the patient's mother or grandmother or 
ancestors have done, nor what her dearest friend, confined a 
few months before her, has done, nor what every woman re- 
garding whose confinement she has ever heard of has done. 
It is a question of careful study by the physician of the indi- 
vidual case. Women would be slow indeed, when reaching a 
certain age, to accept a costume exactly similar to that worn 
by every other woman at that age, and yet in a matter on 
which rests a mother's future health the endeavor is often 
made to enforce a uniform tradition. A woman who had borne 
a number of healthy children, and had retained her own 
beauty, health, and happiness, was asked the secret of her 
continued physical well-being. She replied. " For one thing, 
my mother never allows me to do anything for three months 
after the birth of a child. I get up when the doctor thinks 
best, and have no responsibility for at least three months." A 
woman after confinement was urged by her physician to remain 
recumbent two weeks ; being told by a friend, a woman of very 
different constitution and strength, that she had gotten up 
upon the tenth day, she hastily summoned her physician upon 
that day, with the remark that she could not remain recum- 
bent any longer. So great was her annoyance and restlessness 
that it was necessary to place her at once in a semi-recumbent 
posture upon a lounge, but the change in position marked a 
change in her progress towards recovery which, while it gave 



MOTHERS RECOVERY. 73 

rise to no serious complications, yet made an evident difference 
in her subsequent strength. It occasionally happens that a 
physician has the courage of his convictions, and positively 
refuses to be responsible for a patient who sits up before his 
best judgment permits, but the subject is one upon which both 
physicians and patients can profit by education and mutual 
stud}'. It is quite true that the Indian squaw may drop out of 
the line of march of her tribe and, attended by one or two 
friends, crawl into a thicket and there be confined, and in two or 
three days rejoin her tribe at their next camp. It is also true 
that the healthy peasant woman of Europe, on the average, is 
able to leave the maternity hospital in which she has been con- 
fined on the tenth day thereafter, with a healthy baby in her 
arms. It is frequently observed that farmers' wives in America 
are often up upon the tenth day after confinement, but it is 
equally true that the more delicate inhabitants of towns and 
cities, especially women who have taken little exercise to de- 
velop their muscles, in whom the absurdities of fashion have 
dislocated the abdominal organs by tight lacing and weakened 
the patient's powers of recovery, are no more fit to get up 
the tenth day after confinement than they are fit to do the 
physical work of the squaw, the peasant woman, or the farmers 
wife. They are the women who make the practice for physi- 
cians whose specialty is the treatment of the diseases of 
women, and they are the mothers who fail not only to recover 
their own health, but to nourish their offspring. In this con- 
nection it must be understood that, if the mother be healthy, 
it is of the greatest importance that 3he nurse the child. One 
of the best ways of reducing the womb to its usual size is 
nursing the infant, and it is a happy sign for the American 
people that at the present day it is considered not only not a 
disgrace but also a source of gratification and pride if a mother 
is able to nurse her child. The subject has been thought of 
such importance as to be legislated upon by several European 
countries, and the better physical development of American 
women, resulting from the fact that exercise has become 
d 7 



74 MOTHER AND CHILD. 

fashionable among the well-to-do, has resulted in furnishing 
mothers whose offspring not only profit by their better de- 
velopment, but can also be nursed by them up to a vigorous 
childhood. 



CHAPTEK XXIII. 

DIET AND LACTATION. 

It is often a matter of interest to know how healthy mother's 
milk may be recognized. Of course, the surest proof of the 
pudding is in the appearance and appetite of the one who eats, 
and a well-nourished baby cannot be such without good 
mother's milk. However, in appearance, poor mother's milk 
is very thin, bluish, or occasionally streaked with yellow or 
with red. A sore or cracked nipple may bleed when the child 
nurses, or a sore upon the nipple may form matter which dis- 
colors the milk. If the infant does not thrive, the physician 
can determine by suitable examination whether the mother's 
milk is normal or not, and his attention should always be 
called to any indigestion or lack of thriving on the part of the 
child. The marks of a well-fed baby are its plumpness, rosy 
color, good nature, easj T and lively movements, good appetite, 
and sound sleep. When any one of these characteristics is 
notably absent, there is something wrong which demands a 
careful investigation. The decision on the part of the mother 
that she cannot nurse her child should never be made without 
the physician's approval. In general it may be said that when 
the mother is affected by any serious disease, such as consump- 
tion, puerperal fever, typhoid fever, and other serious troubles, 
that then she should not nurse her infant, but the decision not 
to nurse the child should not be made because she may have a 
sore nipple, or the child may give her pain at first upon 
nursing, and least of all because she dislikes the trouble and 
exertion which the care of her infant causes. Sore nipples can 



DIET AND LACTATION. 75 

almost always be cured by simple means which the doctor will 
direct. A child frequently gives the mother some pain upon 
beginning to nurse, seeming to bite the nipple, but this will 
grow less with time, and finally disappear; and when the 
mother realizes that a refusal to nurse her child means de- 
priving it of eight out of ten of its chances for life, she may 
well hesitate before taking, or desiring to take, this step. 
When a child gives evidence of hunger, as if the mother's nour- 
ishment was insufficient, other food may be added at the physi- 
cian's direction. The mother and nurse, however, must be 
sure first that the child is not thirsty, and the administration 
of water will easily settle this point. In the absence of a physi- 
cian, boiled milk and water, half and half, may be prepared, 
warmed to a blood heat, and fed to the child by a teaspoon or 
from a carefully-cleansed bottle to which is attached a simple 
rubber nipple. If the mother be travelling, and good milk 
cannot be obtained, condensed milk will often bridge over the 
difficulty until she can arrive where proper milk can be had, 
but the administration of anything but mother's milk to an 
infant is a matter so serious as to demand a physician's atten- 
tion. 

The selection of a wet-nurse is also a matter for the physi- 
cian only. It requires an experienced eye to detect in her 
marks of disease which might prove most injurious to the 
infant. The healthy wet-nurse is of course next best to the 
mother, but no task is more difficult than the selection of 
such a woman. Not only should she be of about the same age 
as the mother, her child of relatively the same age and devel- 
opment, her history give no evidence of disease or vice, but the 
physician himself must make a thorough examination to de- 
termine her physical fitness for this important trust. 

It occasionally happens that an excessive flow of milk 
threatens the mother with inflammation of the breast through 
engorgement. This can usually be relieved by withdrawing, 
with a simple breast-pump, sufficient milk to relieve the dis- 
tention. The free administration of saline laxatives, giving 



76 MOTHER AND CHILD. 

the mother a diet which contains but little fluid, and limiting 
her diet somewhat, will often aid in checking the excessive 
flow. The breast-bandage already described is of the greatest 
utility in such cases. A scanty supply of milk may be rein- 
forced by the careful selection of milk-producing articles of 
diet, as already described, by gentle rubbing, manipulation of 
the breast, and by perseverance in urging the child to nurse. 
Occasionally the infant will refuse the nipple ; if then it be 
ascertained that the nipple is naturally formed, is not sore, 
and that the child's mouth is not deformed, a little milk may 
be drawn by a breast-pump and the nipple wet with the milk. 
The child, when then applied, will often grasp the nipple and 
nurse eagerly. The most easy and rational way of determining 
whether the child can nurse or not consists in putting the 
finger in its mouth. It is very rare for a child to be so de- 
formed that the lips cannot grasp the nipple and make suction. 
Prematurely born and excessively weak children may fail from 
lack of muscular strength, but malformation is not common. 
Mothers frequently consult physicians for alleged tongue-tie 
in their infants. This, like deformity preventing nursing, is 
rare, and a little observation will generally convince the 
mother that the tongue can move freely. If the child can 
grasp the finger with the mouth, and the tongue can be felt 
applied upon the under surface of the finger, no serious 
tongue-tie exists. There are deformities in the upper jaw of 
the child, producing what is known as " cleft palate," which 
might cause difficulty in the child's nursing, but such de- 
formities could not be recognized without the assistance of the 
physician. 



PART II. 



CHILD 



BY 
J. M. KEATING, M.D., LL.D. 



7* 



CHAPTEE XXIY. 

CARE OF NEW-BORN INFANT. 

It is not necessary to dwell very long on the care of 
the infant immediately after its birth ; that matter devolves 
entirely upon the doctor and the nurse. But there are a 
great many things that a mother should know about her 
infant, and these we will endeavor to explain as simply as pos- 
sible. 

The child is commonly received from the hands of the physi- 
cian in a soft, thick woollen blanket or cloth, which should be 
warmed before use. The child, when well wrapped, may be laid 
aside in a warm place until the mother's needs have been 
attended to. If the nurse have an opportunity, it is w T ell for 
her to anoint the child's body thoroughly with some simple 
ointment which will assist greatly in removing what is known 
as the vernix caseosa, a cheese-like substance which covers the 
skin. A misapprehension commonly exists that the new-born 
infant needs a plentiful supply of fresh air at once. Eespira- 
tion begins a very few moments after birth, but the child will 
obtain sufficient air if it be entirely but loosely wrapped in a 
coarsely-woven woollen blanket. The head may be covered 
without fear that the child will suffocate, for its lungs are but 
partially expanded, and its respiratory power is often not fully 
developed until some time after birth. 

It is important that the child be protected from draughts of 
cold air, and that its eyes be spared the irritation of strong 
light; hence the folly of keeping the child's head exposed so 
that it may breathe, and of carrying it to a door or window to 
look at it immediately after birth. 

Before giving the bath, its clothing should be selected and 
placed in front of the fire to become thoroughly warmed. In 

79 



80 



MOTHER AND CHILD. 



large bedrooms a folding screen is of great service, and may be 
placed about the nurse and the basin or tub in which the child 
is bathed. It will thus protect the child from draughts and 
allow free ventilation for the mother. The temperature of the 
water should not be less than 100° F., and the soap used white 
Castile or spermaceti (Fig. 11). It should be remembered that 
two separate toilets of the child's body are to be made : that of 
the head and that of the trunk and extremities. Many toilet 
sets contain two washbowls and pitchers, large and small, and 
the smaller set is especially convenient to use in cleansing the 
child's face and head. It is important to do this separately, 
because poisonous material may be conveyed from the child's 
navel to the eyes or mouth. Accordingly, the head and face 

Fig. 11. 



iSsiiii^^i^ 




A convenient folding bath. The tub of heavy rubber cloth. 



should first be bathed, the head being well lathered with soap 
and' the eyes flushed out with a solution of boracic acid (ten 
grains to the ounce) ; this is easily done by using a medicine- 
dropper ; a bit of old handkerchief which has been carefully 
boiled may be dipped in the boracic solution, placed upon the 
tip of the little finger, and the child's mouth be thoroughly 
cleansed. The child may then be grasped with the palm of 
the left hand resting upon its back between the shoulders, the 



CARE OF NEW-BORN INFANT. 81 

fingers grasping the trunk, while the thighs are taken in the 
right hand. It should be lowered gently into the water up to 
the neck, and thoroughly but quickly bathed with a soft, new 
sponge or wash-cloth. Many nurses prefer a bathing-apron, 
consisting of a large, full apron of white flannel. The apron 
is so large that, as the nurse sits beside the baby's tub, a portion 
of the apron lays over her left arm, and may be used as a towel 
when the child is received upon her lap. After the bath the 
child should be powdered or anointed with simple ointment, 
dressed, and laid in its bed to sleep. It is well to give to the 
child, after the first bath, a teaspoon ful of water which has 
been boiled and cooled, as it is not infrequently thirsty. An 
inquiry by anxious mothers and friends is often made as to 
how long the child can survive without nursing: it is even 
thought that within an hour after birth the child must obtain 
nourishment from the mother. It is well to put the child to 
the breast first when the mother wakes from her first nap. 
There is no danger in waiting for several hours until this rest 
has been obtained. The teas so frequently given new-born 
children by nurses are worse than useless, and should be posi- 
tively forbidden. If the child cries and frets, and no other 
cause can be found for its restlessness, it should be laid upon 
its stomach across the nurse's knee, and water as hot as can 
be taken may be given to the child in teaspoonfuls, and, in 
addition, a little peppermint and hot water. Cases are occa- 
sionally met with where nothing but a hot alcoholic stimulant 
seems efficient in controlling the spasmodic contractions of the 
intestines which cause what is known as "colic." Should 
the nipples be sore, nipple-shields should be employed. Of 
these the simplest are the best, as is true of all appliances 
and all articles to aid in the care of the child. The nipple 
should be bathed, after nursing, in a solution of boracic acid 
(ten grains to the ounce), to which has been added a little 
glycerin. 

The child's mouth should also be cleansed, after each nursing, 
with a bit of soft, old linen dipped in the boracic solution 
/ 



82 MOTHER AND CHILD. 

employed for the nipple, carried thoroughly but gently over 
the mouth, gums, and tongue by the little finger. The first 
meal which the child obtains is a partially-formed milk, which 
acts as a laxative. Soon after birth the child commonly has a 
bowel movement which is of a peculiar dark, tarry color, and 
is called meconium. It sometimes resembles burnt molasses. 
The child should have several evacuations of this substance 
during the first day of its life, and colostrum, or material first 
obtained from the breast, is especially adapted to secure this 
result. Should this fail, a simple laxative may be necessary, 
such as a teaspoonful of syrup, or a little castor oil ; but none 
should be given without the doctor's order. 

The child, at birth, is covered with a waxy material, differing 
more or less in amount in different cases. It is said that in 
children who have very delicate skins the amount of this ma- 
terial is often greater than otherwise. 

As it occupies every portion of the body, and can be removed 
by greasing the surface, the new-born child should be thor- 
oughly anointed with either washed lard or vaseline, and then, 
with a soft sponge, tepid water, and a little Castile soap, given 
a superficial cleansing to remove as much as possible of the 
material. Unfortunately, many nurses believe that it is neces- 
sary that the babe should be made thoroughly clean at its first 
washing, and the poor little thing is rubbed and scrubbed 
in a most merciless manner. 

If the birth has been a hard one, or the little one is feeble, 
it would be far better to postpone the thorough washing till 
the next day. The eyes, mouth, ears, and nostrils — in fact, all 
of the mucous surfaces — should be carefully washed with clean 
warm water applied by means of a clean sponge or piece of 
old linen. 

This should be done after the cord has been severed. In- 
deed, it is now customary among many obstetricians to wash 
carefully the child's eyes the moment its head is born. 

Usually the child's mouth, at birth, is full of a thick, viscid 
mucus, and its first cry will cause it to inspire this. As soon 



CARE OF NEW-BORN INFANT. 83 

as possible it should be turned over on its stomach, the head 
somewhat lowered, and the mouth thoroughly cleansed with 
a soft, wet rag. 

The cord, which is the attachment between the child and 
the after-birth, contains the blood-vessels embedded in a gelat- 
inous material more or less thick. As soon as the child is 
born and takes its first breath, the circulation in the blood- 
vessels of the cord gradually ceases. 

It is not at all necessary that the cord of the child should 
oe cut immediately after birth, nor should it be done until 
breathing has been fully established. The cord is usually 
grasped by the hands, and the jelly-like material within it 
squeezed with the fingers towards the mother ; in this way com- 
pression of the blood-vessels takes place. 

A ligature is placed tightly around it, about three inches from 
the child's surface, and another one about three inches from 
that towards the maternal parts ; it is then cut with scissors 
between the two. After the child has received its first wash- 
ing, the navel-string should be enveloped in a mass of sub- 
limated absorbent cotton, folded up in a piece of linen, laid to 
one side, and then the child's binder placed about it. 

The object of this binder is simply to give warmth and sup- 
port the cord. Undoubtedly, if the navel-string were allowed 
to hang, be caught in the clothing, or be pulled about as the 
child receives its daily washing, a rupture might take place. 

Undue stress has been laid upon the value of a binder to 
prevent rupture, and not half sufficient importance given 
to the binder as a protector in our changeable, treacherous 
climate. But it should be remembered that a misapplied binder 
is worse than none at all. It will, if applied tightly, produce 
rupture, undoubtedly, and will interfere with the intestines. 
We recall a case we once had : the babe screamed for hours, 
and the mother and nurse were almost distracted, but failed 
to find the cause. Upon being called, we found a tight 
belly-band which was acting like a vice around a flatulent 
belly. 



84 



MOTHER AND CHILD. 



Many physicians do not approve of a binder for either mother 
or child, and we must confess that if they are to be misapplied, 
we, also, would like to see them discarded altogether. There 

should always be ample room 
for the hand to be run between 
the binder and the skin, and 
the material used should always 
be soft and very elastic (Fig. 
12). ■ 

While the child is being 
washed and dressed it is well 
to secure deep and full respira- 
tions. It is said by old nurses 
that a crying child at birth has 
stronger lungs afterwards. 

If, also, it is turned over on 
its stomach, with head lower 
than the rest of its body dur- 
ing the process of washing, the 
mucus will not be drawn 
in during inspiration, and a 
healthy inflation of the lungs 
will take place. As soon as possible the mother and child 
should get some sleep. After several hours' sleep the child 
can be again washed, if necessary, or sponged off; and this 
time it should be much more thoroughly done. 

The circulation wall be more thoroughly established, and the 
skin will assume the delicate, soft, red appearance of health. 
Extended experience has convinced us that for the first few 
days a little vaseline or cocoa-butter is better to use on the 
child after its bath than the dry powders heretofore in vogue. 
It needs but very slight greasing of the surface to make the 
skin soft and pliable and to prevent eruptions ; and when it 
becomes necessary to use a powder for dusting to prevent 
chafing, the non-scented talcum is decidedly the best ; indeed, 
the only kind to use. 




Child wearing knit binder. 



CHILD'S NAVEL. 85 

The child's clothing should have two important qualifica- 
tions : it should be warm and absolutely loose over all parts of 
the body. 

After the child has had its first nap, attention should be paid 
to its secretions. If the bowels have been moved, use vaseline 
instead of water for its washing ; if it has not passed its water, 
call the doctor's attention to it at his next visit : this is an im- 
portant matter. 



CHAPTEE XXY. 

CHILD'S NAVEL — APPLICATION TO THE BREAST — WET-NURSES. 

In the care of the child, and closely associated with what 
we have described under the head of antiseptic precautions for 
the mother, is the care of the child's umbilicus. As a rule, 
when the umbilical cord is cut, a stump or remnant from two to 
three inches long is left, requiring attention for from five to ten 
days. The dropping off of this cord usually occurs, by process 
of drying, between the fourth and sixth day. The umbilicus 
is left oftentimes in a state of soreness which requires atten- 
tion. This sore may be contaminated by septic poison just as 
any wound upon the mother maybe found infected, and hence 
it should be dressed with some antiseptic dressing. The better 
way is to buy at the druggist's some antiseptic gauze, satu- 
rated with bichloride of mercury or boracic acid. Cotton im- 
pregnated with these substances is often preferable. At each 
dressing of the child, the stump of the umbilical cord should 
be carefully enveloped in such gauze or cotton, laid upon the 
child's left side, and over it should be placed a knit abdominal 
band or flannel binder. This has already been described, and 
need not be repeated here. At the time of bathing, the cotton 
should be cautiously removed and replaced. Care should be 
taken not to make traction upon the cord, and in a few days 
it will have loosened and come away. 



86 MOTHER AND CHILD. 

After the expulsion of the meconium, — the burnt-molasses- 
like substance, to which reference has been made, — the healthy 
child has usually two to four stools in the twenty-four hours. 
They should be bright yellow in color, in consistence varying 
from thinly-boiled to semi-solid corn-meal mush. The functions 
of the kidneys are also early established in the child, and the 
diaper will require changing a number of times during the first 
and second days. The urine is often almost free from color, and 
hence the delusion which exists in the minds of many mothers 
and nurses, that this urine does not contain the usual substances 
in solution, and that the diaper wet with it does not require 
washing, but simply drying before being used again. Nothing 
can excuse the uncleanliness and filth of such a practice, and 
the child's diaper from its first hours of life should not be worn 
a second time unless it has been thoroughly washed and dried. 
It is possible that some cheap absorbent paper may be found 
which can be used for this purpose, and can be burned when 
soiled. If the child does not pass urine freely, simple means 
may be taken to secure its expulsion : placing the child in a 
warm bath ; laying upon the abdomen a flannel wrung out 
in hot water and sprinkled with a few drops of spirits of 
turpentine ; holding the child with its naked back exposed to 
the heat of an open fire or stove, so that decided warmth shall 
be felt. All of these expedients are harmless and in mild 
cases often efficient. A half- teas poonful of sweet spirits of 
nitre in a little warm water will often bring about the desired 
result. 

It will be noted that the navel-string will come away in four 
or five days without any offensive odor whatever. The 
above method of dressing the cord is a convenient one, as it 
does not require to be touched after its first arrangement. 

The navel should be kept absolutely dry, not the least grease 
being used near it; in this way there will be no odor and the 
remains of the cord will dry up and fall off. Should any odor 
be perceptible, the part can be dusted with boric acid or with 
a powder containing one-half boric acid and one-half talc. 



CHILD'S NAVEL. 87 

As a rule, there is very little trouble from the navel, though 
possibly at times, if the child should become constipated, or 
have a severe cough, great straining may take place, when 
bulging or rupture ensues. This can be readily obviated by 
placing a small pad beneath the binder, not exerting great 
pressure ; indeed, a binder which is too tight is more apt to 
cause a rupture than none at all. 

Should there be any discharge from the navel, the nurse 
should make a careful examination of it when the child is being 
washed, and if a small ulceration is found, as is sometimes the 
ease, it can be dusted with boric acid, and if the little red pro- 
jection still remains, and there should be no doctor to call upon, 
it can be touched with bluest one and then dressed with ben- 
zoated oxide of zinc ointment. 

It makes very little difference on which side the child lies 
after its birth. It is scarcely necessary to dwell to any 
great length upon the appearance of a healthy child at its 
birth. 

The soft, peach-like character of its skin, the constant ten- 
dency to sleep, which is uninterrupted and quiet, associated 
with an air of repose, are well-known evidences of health. It 
is not necessary to dwell at length on the fact that the child at 
this age is a noted creature of habit ; indeed, as we come to 
consider infants as they grow, and to study the many causes 
for that most distressing state of affairs, sleeplessness of infants, 
we can trace it back, I can almost say in one-half of the cases, 
to the unfortunate indiscretion in humoring the child when it 
is not more than a few weeks old. 

The young mother feels that the cry of her child must 
naturally come from hunger; but as nature has failed to supply 
constant material for the fountain, she is often indiscreetly 
advised to substitute milk and water or a little catnip tea. 
Our own experience teaches us that this is wrong, and that 
the following procedure is the one to be recommended. 

After the mother has rested thoroughly the child should be 
placed to her breast. Some children will immediately go 



88 MOTHER AND CHILD. 

to work, knowing exactly what they have to do ; others again 
may refuse absolutely to nurse. 

Those that seem to know all about it will find it hard at first 
to obtain any nourishment. After many attempts, and suc- 
ceeding only in extracting what is known as colostrum, a lax- 
ative secretion which precedes the milk-flow, they will from 
sheer exhaustion give up the attempt and fall asleep. 

Infants that refuse the breast cry and fret. To these it 
may be well to give a linen rag moistened in water to suck, or 
a little water with a spoon, and then at a regular definite in- 
terval, say an hour, place them once more to the breast until 
they become used to it. 

There is no danger, under any circumstances, of a child 
starving to death ; for several hours, at least, it can exist 
without food, and needs only a little water; and then, if it is 
placed during the next twenty-four hours, in daytime, every 
hour to the breast, and after that regularly every two hours, 
by the time the flow of milk is thoroughly established the 
child will have its little programme laid down for it, from which 
it must not deviate under any circumstances. If it becomes 
absolutely necessary to feed the child, condensed milk, one tea- 
spoonful to twelve or fifteen of boiled water, is to be preferred. 

Mothers and nurses should recognize the fact that the habits 
which a child acquires in its first few days of existence are very 
hard to break. If it be spoon-fed, it will be difficult to make 
it take the nipple ; if it be bottle-fed with rubber nipple, it will 
be difficult to get it to nurse its mother. 

Then, again, the taste of cow's milk, however carefully it be 
prepared so as to resemble breast milk, will often cause it to 
refuse to. nurse. Often the nipples are so tender or the suction 
will so affect the nursing woman as to restrain the milk-flow, 
and the child will nurse in vain, while the mother will suffer 
such torture that nursing will be abandoned and the child 
be hand-fed. 

A glass nipple-shield will frequently obviate the difficulties, 
or, by gentle pressure and coaxing, sufficient milk can be 



WET-NURSES. 89 

taken from the mother to spoon-feed the babe until nursing 
can be gradually accomplished. We have been so much im 
pressed with the importance of a healthy mother nursing her 
child that we believe in temporizing as much as possible to 
secure this end. 

For about two or three weeks the child should be nursed 
every two hours day and night, and during the periods of 
intermission both the mother and child should sleep as much 
as possible. It is understood that the child should nurse at 
each breast alternately. This is an important matter, because 
a child would soon get accustomed to one breast and refuse the 
other, and this leads to incalculable suffering. After the child 
is nursed the nipple should be washe'd with a little plain water 
or soda, or borax and water, and greased with some vaseline. 

The flow of milk generally begins on the third day. This 
flow may come on suddenly. 

There seems to be a rush of milk to the breasts. Indeed, 
this is usually the way the milk comes at each nursing. 

Frequently the woman will have no evidence of milk what- 
ever, when, at the hour at which her child usually nurses, or 
even at emotion or thought of her child alone, the flow of milk 
will take place. This is especially the case with those who 
have had children before. 

These women sometimes make the very best wet-nurses. 

WET-NURSES. 

It sometimes, as we all know, becomes necessary to decide on 
very short notice the question of having a wet-nurse. We 
will not go deeply into this matter, because the circumstances 
of each case so group themselves as to bring the answer with- 
out consulting a book. The age of the child, the financial 
condition of the family, the residence, are all to b.e taken into 
consideration. 

The wet-nurse should, preferably, have had other children ; 
her child should be about the age of the one she is to nurse ; 
she should be a perfectly healthy woman ; her child should 

8* 



90 MOTHER AND CHILD. 

also be seen, be thoroughly examined, and should give all the 
evidences of perfect health. First of all, the family record 
should be investigated. 

Did her father, mother, sisters, or brothers die of consump- 
tion, cancer, scrofula? 

If she has had other children, were they strong and healthy ? 
Did they thrive upon her milk ? 

If they died, of what did they die ? The physical condition 
of a wet-nurse is as important, of course, as her family record. 

She should have no constitutional disease of any kind ; her 
lungs should be healthy; her skin should be clean, free from 
any eruption, or the remains of one ; her teeth should be good, 
which is an evidence of good digestion ; her eyes bright, her 
muscles firm and well formed ; she should have no loss of hair, 
sore throat, or chronic nasal catarrh, and her breasts should be 
well formed. Then comes the question of temper, and indeed, 
as regards this, it is as hard to get satisfactory testimony as 
it is for the physical condition. 

She should be pleasant in disposition, not stupid; energetic, 
willing, devoid of high temper, and possessed of those traits 
which will soon endear the child to her. Such a nurse would 
probably give about two quarts of milk in twenty-four hours. 

Of course, much of this examination is made by the family 
physician, who is the one to decide whether the nurse is suit- 
able or not ; but there are times in cases of emergency, when 
the mother, or monthly nurse, has to decide. On that account 
we have dwelt at length on this subject. 

The nurse's child should be plump, well formed, free from 
any eruption. Its odor should be sweet and fresh, not sour; 
should it vomit, the material should be simply the overloading 
of the stomach and not sour milk. A healthy baby will often 
take more than its stomach will hold, especially if the mother's 
milk is plentiful and flows freely. 

Having, then, decided upon the health of the wet-nurse and 
on the chances that her milk will be plentiful, she should be 
questioned carefully about her supply of milk. The question 



* WET-NURSES. 91 

as to the employment of a wet-nurse is one with so many- 
phases that in a work of this sort it cannot be answered by 
"yes" or "no." 

Dr. A. Jacobi, writing of the diet of wet-nurses, expresses 
himself as follows : 

" Powerful salts are to be avoided under all circumstances, 
as well the salines as the more powerful drastics, likewise an 
injudicious use of table salt, ethereal oils, and strong condi- 
ments. Furthermore, everything is to be avoided, whether 
of substances taken into the stomach or improper habits, which 
have a tendency to derange or to weaken digestion and assimila- 
tion. Generally the wet-nurse looks upon her position as one 
would regard ' a land which flows with milk and honey,' and 
where 'roasted pigeons fly into the mouth,' — Canaan and 
America at once, — and where there is no end of things to eat 
until the appetite is satisfied or spoiled. Somewhat more of 
albuminous food is indicated than under ordinary circum- 
stances. Too much of this, or a diet composed exclusively 
of it, would destroy health and the milk-secreting power as 
well. Much fluid food and an abundance of water will increase 
the volume of the milk. Water and barley gruel act upon the 
milk as well by virtue of the water which they contain as by 
their nutritious qualities, and the same is true of tea in mod- 
erate quantities. Potatoes, in large quantity, and other carbo- 
hydrates are to be avoided as a principal means of nourish- 
ment. Fat in moderate amount is desirable. In general it 
may be laid down as a fundamental principle that a wet-nurse 
will have the largest quantity and the best kind of milk when 
using the same nutriment to which she was accustomed before 
pregnancy, provided it kept her in good physical condition, 
with the addition of a certain quantity of albuminoids and 
plenty of fluid food. What the nursing woman spends in 
the shape of milk must be returned to her. Where we are 
dealing with small, atrophied breasts, and it is necessary to 
stimulate the secreting function, considerable time is required 
before a free and satisfactory flow of milk can be obtained. If 



92 MOTHER' AND CHILD. 

we are looking simply to keeping up an abundant supply, carbo- 
hydrates may prove satisfactory. The most common question, 
however, is in regard to the improvement of the substance of 
the mammary glands themselves. It must not be forgotten 
that tissue-changes and good health do not depend alone upon 
what is eaten. A wet-nurse must not be thrown too suddenly 
upon conditions which are quite strange to her. She must 
live, as nearly as possible, in the manner to which she has been 
accustomed. A nurse who is removed from the hay-field or the 
kitchen-table to the boudoir of a lady, and who is held in re- 
straint from fear lest she might eat a raw apple, or drink a 
glass of beer, or meet her lover, or who is deprived of her cus- 
tomary physical exercise, will not remain healthy nor give a 
proper quality of milk. In accordance with these fundamental 
directions, the various articles must be criticised which have 
been recommended as proper means of nourishment and diet 
during the period of lactation. The list of such articles contains 
beer (?), buttermilk, milk, chocolate, thick soups, husked grains, 
oysters, crabs, sea-eel soup, etc. If all these dietetic means do 
not accomplish their end, one has to look around for therapeu- 
tic measures for the stimulation of the milk-secreting function, 
with more or less of reason and more or less of confidence." 

If the question be asked, Can a babe be brought up without 
the wet-nurse, depending upon the bottle alone ? we will say 
"yes;" but so careful must be this bringing up, so vigilant 
the nurse or care-taker, so conscientious, so scrupulous in 
attention to details, that one almost feels like saying that if 
a wet-nurse can be obtained who fulfils all the above require- 
ments, — who is healthy, docile, and of an affectionate dispo- 
sition, intelligent, and one especially who has lost her babe and 
takes the new one to her heart in its place, — secure her by all 
means. In times of illness, there are occasions when a wet- 
nurse seems to be, for a time at least, a necessity. 

One objection which is frequently raised by mothers is that 
they do not like to see their babe nursed by other women. 
This may be valid when the balance is equally divided between 



WET-NURSES. 93 

the wet-nurse and the bottle, but where the babe is deli- 
cate, where a strong hereditary taint is present, and the 
chances for the child's future health would be made greater 
by the nourishment it would receive from a strong, healthy 
woman, this objection should have no weight whatever. The 
mother who really cares for the future of her offspring will 
cast aside such feelings and gladly see her child get a start in 
life that will enable it to compete with others in the struggle 
for existence. Indeed, the condition of her own baby will be 
evidence in itself. There are other matters to be taken into 
consideration. 

The nurse's child will have to be taken by some one who will 
give it care, so that her mind may be entirely relieved on that 
score, as anxiety and fretting may cause her to lose all her 
milk in a short time. It must be remembered that she comes 
from a class who, as a rule, are accustomed to much out-door 
life, very plain diet, and regular habits, and that a sudden change 
to a life of luxury, variety in cooking, and over-stimulating 
food is apt to bring about a condition of biliousness, laziness, 
and irritability of temper which is difficult indeed to regulate. 

We have frequently known the very best of wet-nurses, who 
have given satisfaction for a month or so, suddenly, without 
any apparent cause, lose all their milk, and in such cases the 
whole trouble of selection, together with the risk of getting a 
milk which disagrees with the child, has to be gone over. 
Indeed, if under such circumstances the woman proves herself 
to be reliable and affectionate, it is often far better to put the 
child upon the bottle and keep her as ordinary nurse. 

When the question comes up for decision between a wet- 
nurse and bottle-feeding, we should bear in mind that the child 
who is to be subject to city influences should be wet-nursed, 
especially during the hot summer months. We believe that 
bottle-feeding, which, as we shall see further on, requires the 
greatest amount of care and watchfulness, is successful in 
many cases, but the more we see of it the more we are satis- 
fied that every child, if possible, should receive breast-milk 



94 MOTHER AND CHILD. 

until it is four months old; at least this is imperative for a 
city child. 

Of course, when a child is delicate, or where there is an in- 
herited taint in the family, such as consumption, or the family 
is known as a delicate one, wet-nursing becomes all the more 
important. 

The choice of the wet-nurse, when possible, should always 
be left to the family physician ; indeed, a doctor's examination 
of her milk and her baby should always be obtained. 

The system recently established at the nurses' directories in 
our large cities, of having certified wet-nurses, is a very valu- 
able step forward, and should be encouraged by the public. 



CHAPTEE XXYI. 

CARE OF THE BRAIN AND NERVOUS SYSTEM. 

So far as the child's mind is concerned, the fond delusion 
which mothers commonly cherish, that children perceive and 
recognize as soon as born, or soon after birth, must be disre- 
garded. It is probably not before the third or fourth month 
of infancy that the human being perceives. By this we mean 
that while rays of light may fall upon the child's eyes, and 
waves of sound may strike its ears, and sensations of cold or 
warmth or roughness or smoothness be excited in its skin, and 
while sound may be heard as a confused noise, yet the child 
has no idea as to the meaning, source, or character of these sen- 
sations. It seeks its mother as any other young animal seeks 
its natural source of food ; but perception, will, like or dislike, 
other than the animal desires for food, warmth, quiet, and 
muscular movements are undoubtedly absent. The child, 
then, should be treated as a precious but very prosaic little 
animal, and while imagination and affection may detect elo- 



CARE OF THE BRAIN AND NERVOUS SYSTEM. 95 

quence in its cries for food, and rejoice in caresses which are 
largely involuntary, and sympathize with lamentations which 
contain no prophecy except a warning that the stomach is 
empty, all of these manifestations should be taken in the most 
matter-of-fact way. If a vase is to be made by a potter, the 
mass of clay is first prepared, and then the rude shape is turned 
upon the wheel. It is only by repeated applications of the 
hand and the potter's tools that a design becomes apparent 
and the shape takes meaning. The infant resembles at birth 
an organism whose general form is complete, whose design may 
easily be inferred, but which utterly lacks details and connected 
manifestations. It requires the many little touches given by 
the different sights, sounds, and impressions which the child 
receives to mould it into an intelligent being, and this process 
cannot be accomplished to any extent before the period which 
we have mentioned. This disquisition on mental philosophy is 
not introduced to rob the mother of delight in her offspring, 
but to allay her anxieties and enable her to lay aside worries 
which otherwise would injure herself and her child. If babies 
were exhibited more as kittens are,— as objects to be looked at, 
admired, but let alone except by the mother and nurse, — the 
babies would be more comfortable and their mothers likewise. 
If it be true that the child does not perceive until three or four 
months old, it is also true, however, that habits can be formed 
from the day of birth. It is therefore of the greatest impor- 
tance that quiet, regularity, and strict discipline should be the 
atmosphere of the child's first months of life; the object being 
to form a solid physical background for the development of its 
nervous system, this process should not be interrupted, and the 
greatest regularity, the kindest but most efficient care should 
be given not only that it be regularly fed, but that it be fully 
protected from useless disturbance. Any one who has watched 
in a public conveyance a fretting, restless baby trying to sleep, 
while an ignorant mother or the confusion about it prevented 
its slumber, will recognize a species of physical unhappiness 
which is very near frenzy. If the child must be taken in 



96 MOTHER AND CHILD. 

public conveyances, it should be done in the most careful and 
judicious way. The introduction of sterilized milk has made 
it possible to take an infant upon a journey, maintaining the 
regularity of its hours of feeding with the utmost nicety. 
Possibly the time will come when the luxurious trains, which 
now offer the conveniences of a good hotel, will contain cars 
adapted for the transportation of women and infants, where 
sterilized milk can be easily warmed, where' a mother and 
her infant and nurse can occupy their own apartment, and the 
miseries of infant travel be almost removed. It is a familiar 
fact that a child no older than six months can travel with very 
little annoyance to itself and its attendants, if the prerequisites — 
warmth, quiet, food, and sleep — be scrupulously maintained. 
The very fact that the infant ordinarily notices its surround- 
ings very little, makes its transportation comparatively easy. 
There is no reason why these simple prerequisites should not 
be placed within the reach of the poor. In several countries 
of Europe nobility has interested itself in establishing depots 
where sterilized milk can be obtained at the lowest possible 
cost by peasant families. Similar movements are on foot in 
this country, and we trust that the time will soon arrive when 
sterilized milk, and any other food which science can prove to 
be essential for infants, may be obtainable at or near our great 
railway stations. Of course, a nursing child needs only its 
mother's food, but the mother should receive the same consid- 
eration as is shown the child, and thus her nourishment will 
remain uninjured by fatigue or deprivation. 



THE NURSING OF INFANTS. 97 

CHAPTEE XXVII. 

THE NURSING OF INFANTS. 

We have elsewhere written 1 as follows, when on the subject 
of nursing : 

How much food does a babe require in twenty -four hours ? 
Much depends on the infant : if the bowels be normal and 
there is no evidence of indigestion, the breath sweet, and the 
child seems desirous for more after it has finished its bottle, 
there is no reason why it should not be satisfied. 

From birth until it is a month old a babe should be nursed 
every two hours ; it will take one ounce or a little less at each 
feeding. There is one matter of great importance, and that is, 
the child should be made to nurse from both breasts from its 
birth, alternating at each nursing. 

It is strange that an infant nearly always shows a prefer- 
ence for one breast, and there may be a struggle to conquer 
this ; nevertheless, the battle must be fought, or the neglected 
breast will give much trouble. 

Dr. Jacobi says, " The child ought to drink from the breast 
or the bottle until it has had enough. It takes twenty to 
twenty-five minutes to empty one or both breasts. After 
having nursed, the infant should be quiet, should play with its 
arms, should breathe somewhat more regularly than usual, or 
go to sleep. If it be not allowed to have absolute rest, if it be 
rocked, allowed to lie on its belly, or be carried around, lying 
face downward upon the hand of the person carrying it, vom- 
iting will be provoked. The facts which have been introduced 
show that nature requires play-room; even the most careful 
measurements may be incorrect." 

A child a month old should be nursed about ten times in 

1 Annals of Hygiene, July 1, 1886. 
Kg 9 



98 MOTHER AND CHILD. 

twenty-four hours, — every two hours during the day and three 
hours during the night; at each nursing it should take from 
two to three ounces of milk. At the age of three months it 
will probably nurse only about eight times, taking some six 
ounces at each feeding; at the end of six months it will take 
about eight ounces. 

We believe that the above represents about the amount of 
breast-milk that a very robust child would receive, though Dr. 
Rotch makes the estimate a little less. 

The child gets the same food as does an adult, — that is to 
say, the milk which forms its diet is composed of all the arti- 
cles of food that enter into the diet required by a human being. 
These may be divided into five classes : water, caseine (curds) 
or albuminoids, salts, which go to the formation of bones and 
secretions, fats and sugar, which are burned up to make ani- 
mal heat, and are also valuable in nutrition. Eighty-seven 
parts of a child's food is water, but then we know that seventy 
per cent, of the human body- weight is water. 

Mother's milk is a bland, watery substance, sweetish to the 
taste, and has the property of forming curds in flakes ; whereas 
the milk of the cow precipitates in heavy masses, as a rule, and 
is on that account difficult of digestion. 

A healthy infant, if properly instructed in the earlier hours 
of its life, will awaken with the regularity of clock-work and 
seek its meal every second hour. It should be placed at the 
breasts alternately, and after it has received its nourishment 
it will probably fall asleep, showing no evidence of indigestion 
or flatulence, so frequent in bottle-fed children. Babies are 
very apt to get into the bad habit of falling asleep after 
taking two or three mouthfuls. Should this habit be en- 
couraged, it will be very difficult to break. The child should 
be promptly awakened and made to continue the meal until it 
has taken a sufficient amount. 

At the third month a child should nurse about every three 
hours, or possibly, if it is a large child, craves food, and takes 
a great deal at once, every two hours during the day and at 



THE NURSING OF INFANTS. 99 

longer intervals at night. If the mother has a very free flow 
of milk, — more, indeed, than she can possibly retain, — it is 
well for her to wear the ordinary disk or cracker-shaped nip- 
ple-glass during the daytime, with a towel pinned over it, 
which will absorb the surplus milk, and will prevent her 
being constantly wet and catching cold. As can be readily 
understood, the breasts of a nursing woman demand con- 
stant attention. The nipples being of various shapes, there 
is often a singular want of compatibility between them and 
the infant. Often a nipple will be so small that the child 
cannot grasp it readily, and in its great impatience it will fail 
to effect any suction whatever; then, again, the nipple will be 
too large a mouthful, and a free flow of milk will almost choke 
the child. These conditions can be regulated by the mother 
grasping the nipple between two fingers (index and second) 
of the unoccupied hand, and either making gentle pressure 
to increase the flow or restraining the current by slightly 
squeezing the nipple at its base. Some nipples are sunken 
in, and it is impossible to keep them sufficiently raised to 
allow the babe to grasp them or to prevent chafing and crack- 
ing at their base. It is wrong to attempt to harden them by 
astringents ; they should be kept clean, free from any acidity, 
dry, soft, and pliable. They should be sponged off with a 
weak solution of boric acid in water after each nursing, and 
then thoroughly dried and the base anointed with a non-irri- 
tating salve, — something that will not be disagreeable in taste 
or odor to the child. White vaseline or cocoa butter is as 
useful as anything ; the latter can be rubbed up with a little 
glycerin to make it softer, if necessary. There is an excel- 
lent old fashioned salve, known as "Pomade Divine," de- 
scribed in many old English books. It is made of wax, 
suet, herbs, etc., and no better ointment of a soothing, heal- 
ing character can be found. Many people keep it to put on 
bruises. 

Some mothers suffer the most intense agony, at first, when 
their babes nurse ; they become nervous, and the very thought 



100 MOTHER AND CHILD. 

of it puts them into such a nervous state as either to entirely 
stop the milk-flow or certainly to make the milk disagree. 
When this is the case a glass shield with rubber nipple will be 
of service, for a few days at least, until they become accus- 
tomed to the suction. Breast-pumps should never be employed 
unless ordered by the doctor, and then only under the super- 
vision or direction of a trained nurse. 

What should be done if the breasts cake or become tense? 
If the flow comes very quickly this is apt to occur when the 
demand of the child is not equal to the supply. To prevent 
this, and to relieve it when it takes place, there is nothing 
better than gentle but firm stroking of the breasts from their 
margins towards the nipple. Hot lard is the best thing to 
use for this. Some nurses have a special knack of relieving 
engorged breasts in this way. The breasts should be sup- 
ported by a suspensory bandage : a soft towel, folded bias, 
passed beneath the breast and arm and tied behind the neck, 
or a silk handkerchief, is the best thing to use for this. 
Nursing women should be most careful not to get chilled; 
although possibly breast abscesses are more apt to follow sore 
nipples and bruises, they may result from cold, and are indeed 
most serious things. Sleep and exercise, ease of mind,— a 
contented disposition, — are of great importance to a nursing 
mother; fresh air and good food stimulate the appetite and 
make good milk. A daily sponging of the body, or a bath, 
makes the skin do its share of work and keeps the other organs 
in good working order also ; in a sleeping room, fresh air with- 
out draught is essential. If these things are necessary for the 
mother, they are equally, if not more, so for the wet-nurse, 
and the mother must see that they are attended to. 

Colic is so frequent in nursing as well as bottle-fed babes 
that it is not out of place to consider it here, though when 
writing on bottle-feeding we will dwell more at length upon it. 

What a mother wants to know is how to distinguish the 
various causes of colic, so that she may properly apply 
those domestic remedies that will relieve it. Frequently 



THE NURSING OF INFANTS. 101 

a babe will be seized with severe pain at the first attempt 
to nurse; it will suddenly scream, draw its legs up, and re- 
fuse the breast. If this were due to flatulency, the belly 
would be round and tense. It is the result of what is 
called reflex action or stimulation transmitted from one set 
of nerves to another; the intestinal canal is set in motion and 
its nervous centres are stimulated by the act of sucking, just 
as the sight of food makes an animal's mouth water. There 
ought to be a rule that, whenever a babe screams suddenly, 
with evidence of acute pain, all its clothing should be re- 
moved to search for erring pins or too great pressure. Ear- 
ache is a frequent cause of acute pain in babes, and is often 
overlooked, but it is most common in infants of over three 
months, and it would be well for the mother to send for her 
doctor should the child not be relieved by the measures in- 
tended to check intestinal colic ; he may be able to locate the 
pain elsewhere and suggest appropriate measures. 

The presence of food in the stomach and intestines will 
often induce colic, until the digestive processes are fairly 
established. That is one reason why it is desirable to allow 
the child to nurse at regular intervals only, and to apply it 
early to the breast, while the mother's milk is scanty. The 
early secretion from the mother's breast has a somewhat 
laxative effect, and probably is intended to act as such in 
order to purge the babe's intestinal canal of the accumulations 
that have taken place during its foetal life. If the babe has 
colic following the first attempt at nursing, it is often advisa- 
ble to give it a teaspoonful of olive oil in a teaspoonful of 
warm liquid "soda mint" before nursing, and to draw from 
the mother the first secretions. Another cause of colic is 
overloading of the stomach and intestines. Some babes evince 
a greediness which is remarkable, or the flow of milk may 
be totally beyond their storage capacity, and from bulk alone 
promote pain. Again, fermentation may take place very 
rapidly. Some babes regurgitate the milk Yerv readily, and 
thus the bowels do not suffer from distention by the gases 

9* 



102 MOTHER AND CHILD. 

of decomposition. Mothers often complain of this and fail 
to see that it is nature's safety-valve ; indeed, it is only the 
excess of food that is got rid of in this way. A babe can 
digest only a certain amount and no more; the amount that 
can be digested differs with every infant. It is not the amount 
of food a babe takes into the stomachy but the amount it digests, 
that does it good: this must never be forgotten. One often 
sees a babe crying from colic, and the nurse or mother at- 
tempting in vain to soothe it by dancing it up and down or by 
singing a lullaby ! Imagine the torture to the poor little one 
from such a proceeding ! Unless a vent for the wind be found 
the crying will continue, and the wonder is that convulsions 
do not oftener occur. "When a child, then, has colic, do not 
nurse it ; unclothe it, give it a warm drink by the spoonful, — 
catnip tea, liquid soda mint (some advise gin and water, but, 
as a rule, we are opposed to any stimulants in such cases unless 
ordered by the doctor). Rub the abdomen very gently from 
right to left with some warm olive oil, or, what is still better, 
let the child lie face downward on the lap and gently rub its 
back with some warm liniment, or even the bare hand. If it 
still continues to cry, give an enema of a teaspoonful of tincture 
of assafoetida in two ounces of water, introduced very gently; 
and if the pain still continues after the enema has acted, put 
the feet in hot water, tested first by the mother's arm that it 
may not burn. Should this fail, send for the doctor. 

The strictest attention should be paid to the clothing of a 
babe ; not infrequently colic may be caused by cold, especially 
cold feet. Sometimes a babe will seize the breast with avidity, 
give a few attempts at sucking, apparently choke on the milk, 
and cry. This may be caused by cold in its head, the mucus 
stopping the nose so that it is impossible for it to breathe and 
suck at the same time. The doctor's attention should always 
be called to the babe's nose if it has sniffles, or if it breathes 
noisily or with difficulty, that he may use appropriate meas- 
uaes to clear out the nasal passages. The nurse should take 
care, when washing the child, and especially in cold weather, 



THE NURSING OF INFANTS. 103 

that it be not in a draught. I have often seen a faithful nurse 
bathing a babe in a stifling hot nursery, near the fire probably, 
and the constant opening and shutting of an adjacent door 
supplying a direct draught to the child. In my experience, 
nasal catarrhs are. very common with infants. 

In choosing a wet-nurse it is, perhaps, better to select one 
who does not menstruate. Not that ordinarily normal men- 
struation will affect a nursing babe after it is three or four 
months old ; but excessive menstruation will act as a drain 
upon a woman and certainly affect her milk. Matrimonial in- 
tercourse need not, either, interfere with nursing, provided it is 
indulged in with caution and in moderation ; but great watchful- 
ness must be exercised over wet-nurses in this matter, coming 
as they frequently do from a class not over-particular in morals, 
unless one is fortunate enough to secure a married woman. 
Wet-nurses are liable to excesses, and these will have a very 
baneful effect upon a delicate child ; indeed, this and intem- 
perance is a risk always run. The child being healthy, it may 
be well to gradually enlarge its bill of fare as it grows older, 
in order to accustom it to a change in diet, or to prepare for 
any change that may become necessary. It has been said 
that a child digests bottle-food when it also takes breast-milk, 
and therefore that weaning should be a gradual process, — so 
gradual, indeed, as to take several months for its accomplish- 
ment. When it is deemed desirable to substitute it for breast- 
milk, the bottle should be given in the daytime, after the 
morning bath; or better still, if the nurse has the child, to 
give it the breast in daytime, so that the mother may get her 
night's rest. By this time the child takes, as we have noted, 
more food at each nursing and nurses less frequently, and now 
it may have the bottle at about ten or eleven o'clock at night, 
when the mother retires ; in this way she can nurse the child 
at the early morning hour, and thus avoid the exposure of 
getting up and preparing a bottle of food at that hour, if she 
takes charge of the child herself. 



104 MOTHER AND CHILD. 

CHAPTEK XXYIII. 

BOTTLE-FEEDING. 

If we have impressed sufficiently upon the reader the impor- 
tance of care in the selection of a wet-nurse, we did not do so 
with the object of undervaluing the subject of bottle-feeding 
by contrast, although there is no question but that the valu- 
able suggestions, the outgrowth of careful study, that have 
been published by such writers as Leeds, Smith, Meigs, Jacobi, 
Eotch, and others in this country have impressed upon the 
community the fact that the raising of children by means of 
the bottle is by no means as difficult a matter as it was thought 
even ten years ago. They have all premised their teachings 
by impressing the fact that care is the primary step to suc- 
cess. If it is a difficult matter to keep a wet-nurse in order, 
it is no less difficult to give the requisite attention to each 
bottle. One bottle of tainted milk may be fatal to an infant, and 
though a mother or nurse may day after day watch with the 
most zealous care the preparation of the baby's food, the 
souring of the milk, its admixture with contaminated water, 
the change of pasture of the cow, may bring on an attack of 
diarrhoea or vomiting which would be uncontrollable. We wish, 
therefore, to impress upon all those who have anything to do 
with the bottle-feeding of children that a child, not exposed 
to the dangers of a large city in the summer-time, can be 
brought up on the bottle from the day of its birth and be free 
from disease, become strong and healthy, provided the same 
attention is given to it as would be given by a mother to her new- 
born nursing babe. At the same time, we believe that every 
mother should be impressed with the fact that no form of 
bottle-feeding, however perfect it may be, and however 
closely it may resemble breast-milk, can take the place of 
breast-milk for a child under three months of age. Breast- 



BOTTLE-FEEDING. 105 

milk is the ideal infant's food, and if we dwell at length upon 
bottle-feeding, we do not for a moment wish it understood that 
we undervalue the milk of the mother or, next to it, that of a 
reliable wet-nurse. 

The first requisite for carrying out bottle-feeding with thor- 
oughness is that somebody should take charge of the child who 
has a special interest in it. If we are talking to a young mother 
whose milk has given out, or whom the family physician has 
advised to bottle-feed her child, then she is the one to undertake 
the work, and either to prepare each bottle or to superintend 
its preparation for a time at least. Possibly she has had a wet- 
nurse whose milk has gone, and it has been decided to use a 
bottle instead of procuring another. Then let that nurse 
undertake the duties. She has a special interest in the child 
who has drawn its nourishment from her breast. If not, then 
get some middle-aged woman, not too old or cranky, or over- 
burdened by previous experience, but never a small chit of a 
girl who would require a nurse to look after her. Strange to 
say, these latter are often engaged as child-nurses, and no won- 
der the doctors are kept busy. Choose a middle-aged woman, 
or a strong, healthy young woman of intelligence, — one who is 
bright, cheerful, satisfied. Make your pecuniary arrangements 
with her perfectly satisfactory, so that she has nothing what- 
ever on her mind. After you have tested her ability, give her 
your entire confidence ; let her see that she is trusted. It is 
well that the child and nurse should have a room to themselves 
near to the mother's bedroom, and this room should have in it 
two things of great importance : one, a small sick-room refrig- 
erator ; the other, a gas-lamp or something by which the milk 
or water can be readily heated. It is necessary to have a half- 
dozen nursing-bottles holding about eight ounces each. A 
child a month old will take not quite one-quarter of this at each 
nursing. At the age of six months it should take at one feed- 
ing about six ounces. As there is more danger of decomposi- 
tion from cow's milk, it is wiser to give an infant less bottle- 
than it would get breast-milk at the same age ; but as the 



106 MOTHER AND CHILD. 

capacity of a babe's stomach is in proportion to the weight of 
the child, a feeble babe needs less food, but the intervals of its 
nursing may be made somewhat shorter ; an extra bottle may 
be given at night. Overfeeding is a great cause of diarrhoea. 
Most mothers overfeed their bottle-fed babies : it is a temptation 
hard to resist ; but the lesson is frequently a bitter one. It is 
far better to underfeed for a time, and let the doctor regulate 
the increasing diet, which he can gauge by the child's weight. 
A gain in weight and a healthy condition of the passages is 
the test of the amount of food a babe should receive. The 
average healthy babe may gain by proper food from a half to 
one ounce a day in weight for the first four or five months, and 
half that amount daily for the rest of the year. The question 
as to whether a woman becoming pregnant should continue to 
nurse her child is one to be left to the family physician to 
answer. 

The fresher the milk the more readily it will be digested ; 
indeed, we feel satisfied that the warm milk, just from the cow, 
is far more digestible than that which has been kept with every 
precaution for a few hours. There must be some change which 
milk undergoes, as it is noted by all observers that the milk 
when warm from the cow is but slightly acid, or neutral, by 
litmus paper, but after it has stood for a while it always shows 
a very decided acid change. Mother's milk is always slightly 
alkaline. 

The greater part of the secret of success in bottle-feeding is 
to have pure, fresh milk ; and we would say beforehand that if 
there is the least doubt of the character of the milk served, 
there should be no hesitation about putting the child at once 
upon condensed milk until this matter is thoroughly investi- 
gated ; though it must be remembered that the condensed milk 
must be either sterilized or treated with boiling water, as will be de- 
scribed later, just the same as would be cow's milk. Although 
one may be most careful in the selection of a milkman, in the 
city, yet the jolting that the milk gets in transit, the risk that 
is run from diseased cows, dirty cans, contaminated water in 



BOTTLE-FEEDING. 107 

milk-houses, is by no means small, and especially during the 
heated season, when the child's intestinal tract is weakened. 
These causes of bad milk are followed by disease ; possibly 
this accounts for the fact that milk from the same dairy that 
has agreed perfectly during the spring months will sometimes 
disagree with the child in summer. 

So much attention has been paid to this matter recently that 
the public has become interested in the establishment of dairies 
where every precaution is taken to secure the very best of 
milk by legislative interference. The pasture and winter- feed- 
ing should be regulated ; the health of the cattle, the methods 
of preserving the milk, and its transportation looked after; 
the milk-inspectors should be on the alert to prevent the intro- 
duction of such substances as boracic acid or salicylic acid to 
preserve the milk. 

Great care should be taken in the selection of milk, and in 
its preservation, even after it has reached the house, until 
used. The milk should always be tested with litmus ; if it is 
alkaline, it has been made so by the addition of some preserva- 
tive. Cow's milk always presents to litmus paper more or less 
acid reaction, turning the litmus red. If there is the slightest 
suspicion that the milk has been watered, is not very fresh, or 
that it has been subjected to much jolting, our opinion is that 
it should be boiled at once and then put in a refrigerator, 
and warmed for each bottle. The boiling will destroy its fer- 
ments, and in that way diminish the chances for intestinal dis- 
turbances ; but boiling will not make milk sweet that has been 
turned or make fresh that which is stale. 

The propriety of obtaining milk from a single cow is one that 
has been frequently insisted upon, and if one is satisfied that 
such milk is obtained and is found to have agreed with the 
child, it may have many advantages ; but we think that the ordi- 
nary mixed milk from a dairy of common cattle will be less 
liable to daily changes ; it will maintain, as it were, an average. 
Not only should the milk be pure and sweet, but it should be free 
from all matters that carry disease with them. Our medical 



108 MOTHER AND CHILD. 

literature contains very many authentic cases of scarlet fever, 
typhoid fever, and diphtheria which were undoubtedly carried 
from the dairy by means of the milk, the farmer's family suffering 
at the time from the disease in question. If, for instance, the 
water of the milk-house should be contaminated by an out- 
house well, and the washing of the pans convey these materials 
to the milk, the result, of course, would be apparent ; indeed, 
milk is undoubtedly frequently diluted, and the water will 
carry the germs with it. Milk also has the propensity of ab- 
sorbing odors and gases that probably contain the germs of 
disease. Milk also may contain the germs of disease affecting 
the cow herself: so we see that there is a great risk to be run, 
and be we ever so careful and watchful we can only avoid the 
most apparent evils, and will have to trust to Providence to 
save us from the others. 

If each householder was more particular about his milk, 
gave it the strictest watching, and if the laws in regard to that 
outrageous and most criminal proceeding, the adulteration or di- 
lution of milk, were rigidly enforced, dairymen would soon 
feel the importance of obtaining and sustaining a reputation 
for honesty. It is a very difficult matter to reach the legisla- 
tors of the land, those who make its laws ; but possibly, by 
placing these matters in a clear light before their wives, they 
will be made to see the criminality of adulteration of food 
when it becomes a matter of their own individual interest. We 
lay great stress upon this subject, because absolutely pure, fresh 
milk — that used immediately after milking — does not have to be 
sterilized or boiled, as it is free from germs of disease or fer- 
mentation. Sterilizing and boiling the milk implies that a 
doubt is cast upon its purity. A babe will not thrive as well 
upon boiled or overheated sterilized milk as it will upon the 
fresh article ; but unless a person has access to a cow and can 
milk it for each bottle (which is the thing to do, when possible), 
no danger of diarrhoea and indigestion should be incurred : the 
milk must be rendered sterile. Or if this be not convenient, 
the cow can be milked twice a dav, with the following precau- 



BOTTLE-FEEDING. 109 

tions : The bag and teats must be thoroughly washed, and the 
cow then milked directly into a well-scoured jug or large bottle ; 
this should be corked at once and placed on ice, and a sufficient 
portion poured from it to make up each bottle. 

I dwell at some length upon the importance of considering 
step by step the preparation of a child's bottle, and this is done 
because it becomes a monotonous work, and unless the mother 
sees to it personally, the nurse, however devoted, may some 
time or other become a little careless, and the result may be 
the souring of the milk, formation of curd, and inflammation 
of the bowels, and its consequences. 

Dr. Parker recommends a pure gum nipple, with two holes 
as far apart as possible, as the best for the nursing-bottle, 
and in this connection makes the following remarks : " When 
there is only one hole, the infant, in nursing, compresses the 
nipple and sends the milk in a stream in such a manner as 
often to nearly strangle itself. Milk coming through one hole 
is not as comfortable as when it comes through two, and the 
effort of nursing becomes disagreeable and wearisome to the 
little feeder. The best way to nurse an infant is by holding it 
in the arms, and give it the bottle in the same position and 
at the same height as if it were really being nursed by its 
mother. When it has finished nursing, the bottle should be 
removed, emptied, and cleansed. Never should the bottle be 
left in the infant's care to use at will." 

We all acknowledge 1 that cow's milk has the following ad- 
vantages : it serves as the basis for the preparation of a milk 
resembling that of the mother; it contains all the ingredi- 
ents that are necessary for nutrition ; it is easy to obtain. Its 
disadvantages are : that the relative proportion existing be- 
tween its different constituents is not that found in mother's 
milk ; it contains a form of casein which forms hard curds ; 
this casein exists in larger amounts (at least twice as much) 
than in human milk. It is acid. 



1 Dr. Keating 's paper, read before the Convention of State Boards of 
Health in May, 1886. 

10 



110 MOTHER AND CHILD. 

A certain time must elapse during which the milk undergoes, 
possibly, some alteration from exposure to the air, and is liable 
to be tainted with the germs which produce decomposition ; 
this, indeed, is the greatest objection to its use in our large cities. 

It is scarcely necessary to impress upon mothers the im- 
portance of always using clean nursing- bottles. Unless the 
following rules are strictly adhered to, there is no use of 
reading this book further. 

1. Have a number of nursing -bottles, so that a perfectly clean 
one is always in use. 

2. Keep the extra ones, after thorough washing in boiling suds 
and water, in your sterilizer or in a pan of boiled water, with a 
teaspoonful of borax and soda in each. 

3. Use only plain black rubber nipples, have a number on hand, 
and treat the unused as you treat the bottles. 

4. Never use nipples with tubes. 



CHAPTER XXIX. 

STERILIZING AND STERILIZERS. 

By sterilizing milk, water, or, in fact, any material, we mean 
destroying within it those germs which render it more or less 
noxious, and making it for a time thereafter an infertile soil for 
the growth of germs. This may be done (1) by boiling, (2) by 
more or less prolonged steaming, (3) by keeping the milk at 
about 155° F. for six minutes, (4) by the use of chemical 
agents. The latter would be as harmful to the babe as they 
would be to the germs. Every bottle given to a babe should go 
through one of these sterilizing processes. Moreover, all the 
ingredients of the bottle should be sterilized, and the food 
must be either prepared as needed or made up in bulk, and 
that drawn from as needed, provided that bulk is most jeal- 
ously guarded. The whole matter, indeed, would be simplified, 



STERILIZING AND STERILIZERS. Ill 

provided we could be certain that milk raised to a temperature 
of 212° F., was as nourishing as that which is raw, and pro- 
vided also that those ingredients which we are obliged to add 
to cow's milk were not altered by so high a temperature. We 
will deal with these methods in detail. 

1. What are the advantages of boiling the milk ? As a 
sterilizer, boiling is certain ; there can be no question about it. 
The germs of typhoid fever die at a temperature of 132.8° F., 
but it takes a temperature of 212° F., a short time sustained, 
to completely destroy those of tubercular disease. 

Boiled milk will keep sweet, when exposed to the air, at least 
twenty-four hours. Boiling is most readily accomplished ; it 
needs only such kitchen apparatus as every household, however 
poor, has already. Boiled milk, in summer, will control diar- 
rhoea; in fact, one of the objections is that it is constipating ; but 
on the whole, taking everything into consideration, in emer- 
gencies, or when there is the least doubt about the character 
of the milk or the dairy it comes from, the advantages of 
boiling a child's milk in the preparation of its food are greater 
than the disadvantages. What are the disadvantages? The 
principal disadvantage, we are told, is that boiled milk is not 
as nutritious as raw milk ; but as the most eminent authori- 
ties have taken opposite sides in this matter, we can take 
whichever side is most convenient and most judicious at the 
time, and watch carefully those indications which point to gain 
or not in the child's weight and nutrition, and act accordingly. 
Dr. Eotch tells us that the investigations concerning the 
relative digestibility of raw milk and boiled milk are so con- 
trary in their results that he will not dwell upon them in his 
article. The principal disadvantages, in our opinion, are the 
tendency to constipation and the fact that the usefulness of 
lime-water and milk-sugar is in a measure destroyed by the 
high temperature. 

2. What are the advantages of steam sterilizing? The 
gradual increase of temperature to the boiling-point by means 
of steam does not have the effect upon the milk of changing 



112 MOTHER AND CHILD. 

its taste, or of rendering it so constipating. The milk thus 
prepared is claimed to be as thoroughly sterilized as when 
boiled in the ordinary way. It is claimed for this process that 
it has no outward effect upon the milk, leaving it appar- 
ently the same as if it had not been sterilized, but that 
the process is a most thorough one, and when the proper 
apparatus is used, is the simplest possible way of preparing 
child's milk. "We have strongly advocated this method ever 
since its suggestion by Dr. Soxhlet and the strong argu- 
ments used in its behalf by Dr. Caille, of New York, and we 
believe that the number of lives that have been saved by this 
measure is incalculable ; moreover, we felt certain that the 
purchase of a sterilizer, and the enthusiasm attached to a new 
thing, would stimulate mothers and others interested in infants 
to more care in the details of feeding and in the preparation 
of the milk. Many who would scorn the proposition of using 
boiled milk would jump for joy at the thought of a sterilizer 
instead of a farina boiler. This process applied to dispensary 
practice, as is the case already in some of the large cities, 
will save hundreds of babes who would otherwise succumb to 
tainted milk. 

Undoubtedly the best form of steam sterilizer is the Arnold, 
manufactured by Wilmot, Castle & Co., Eochester, New York 
(Figs. 13 and 14). 

In order to make this matter thoroughly understood we will 
quote at length from Dr. Walter Mendelson's article in "Baby- 
hood " upon the subject of the Arnold sterilizer. 

"Precautions. — The milk (or mixture of milk, water, cream, 
and sugar suitable to age of the child) should be prepared as 
early in the morning as possible, before the heat of the day 
has caused the bacteria to multiply. Enough should be made 
up for the whole twenty-four hours, by multiplying the amount 
to be used in each bottle by the number of bottles needed. In 
making the mixture use a pitcher previously cleaned with hot 
water and soda and by plenty of rubbing. Simple rinsing is 
Dot enough; so let the pitcher be sufficiently large to easily 



STERILIZING AND STERILIZERS. 



113 



admit the whole hand. Scrupulous cleanliness must be insisted 
on at every step. It is the indispensable element of success, 
for bacteria nourish in dirt. 

Fig. 13. 




" Bottles. — The bottles should be the plain, old-fashioned kind, 
without shoulders, and with a flat bottom, so that they may be 
stood upright. There is much complaint of the bottles cracking. 
h 10* 



114 



MOTHER AND CHILD. 



To avoid this, heat the sterilizer rather slowly at first, and 
when the bottles are taken out do not put them upon a cold 
marble wash-stand, or in the draught of a window-sill, but place 
them, rather, upon a wooden table to cool gradually. Bottles 
will last longer if annealed, which may be done by placing them 
in a large pan of cold water and gradually heating this to the 
boiling-point, and as gradually allowing it to cool again. They 
should be of such a size that when filled with the quantity 
needed, there will be at least two inches of space between the 

Fig. 14. 




surface of the milk and the lower end of the stopper, so as to 
prevent the latter being wet with milk. 

" Too much attention cannot be bestowed upon the care and 
cleaning of the bottles and nipples. New bottles should be 
thoroughly scoured with a hot solution of washing soda and a 
bottle-brush. If, by chance, milk has soured in a bottle, it 
should be well boiled in soda, then thoroughly rinsed, and set 
aside for several hours, filled with hot water to which a tea- 
spoonful of borax has been added. When the child has finished 



STERILIZING AND STERILIZERS. 115 

nursing, the bottle should not be allowed to stand about with 
the remaining milk in it, but should at once be emptied, rinsed 
with hot water, and left filled with borax water till the time 
for final cleaning. 

" It is often quite difficult to thoroughly clean a bottle, es- 
pecially of the greasy rim that forms at the level of the milk. 
After trying many things, I have found that ' pearl ine' gives 
the best results. Use it with hot water and a bottle-brush. 
Fine specks, consisting probably of some crystalline compound 
of the milk sugar, are often found adhering with great tenacity 
to the inside of the bottle. Those that still remain after using 
the brush may safely be left. After cleaning and thoroughly 
rinsing in fresh water, the empty bottles should be put on some 
shelf, out of the way of. being splashed or soiled in any way. 
It is not necessary to keep them filled with water. In filling 
the bottles, always use a funnel — by preference a glass one — 
with a stem an inch and a half or two inches long. In this 
way you prevent the inside of the neck, the top, and the out- 
side of the bottle from being wet with milk, which might, 
later, prove a path along which germs from without might, 
travel downward into the milk. Should the bottle, after all, 
have become wet with milk, let a few drops of water run down 
the inside of the neck and over the top, to wash away that 
which may have lodged there. Never use the same bottle for 
more than one feeding. This is a cardinal rule, and I have 
known all the good effects of sterilizing to be done away with, 
and a child become very ill, from its having been disobeyed. 

" Stoppers. — The best stopper consists of a plug made of ordi- 
nary cotton batting (not necessarily absorbent cotton), folded 
into a pretty firm wad, and pushed down for half an inch or 
more into the neck of the bottle. Make sure that there is no 
milk about the mouth of the bottle when the plug is put in, 
and that the stopper is not wet with milk from shaking the 
bottle before being put into the sterilizer. The advantages of 
cotton stoppers are : that they are clean, — being always used 
new ; that they are cheap j and that they save labor by re- 



116 MOTHER AND CHILD. 

quiring no washing, as rubber ones do. When the bottle is in 
the sterilizer they allow the heated vapors to escape, and when 
it is cooled again the outside air re-enters filtered of all germs 
by the cotton it has had to pass through. Eubber stoppers, 
with a hole for a glass plug, are not readily cleaned. Those 
with a notch in the side, as in Seibert's apparatus, are better. 
Only when bottles have to be kept a long time, as for sea- 
voyages, are rubber stoppers to be preferred to cotton ones. 
The cotton stopper must not be removed until the bottle is 
wanted for nursing, and it should then be withdrawn with a 
twisting motion that will carry all the fibres with it. 

" Nipples. — The plain conical, pure gum nipple, that has no 
constrictions in it, and can be easily turned inside out for 
cleaning, is the best. Nipples should be scrubbed clean like 
the bottles, and when not in use, kept in a glass of water, to 
which a teaspoonful of borax has been added." 

What are the disadvantages of the steam sterilizer? They 
are precisely the same as attend boiling. Lately, Professor 
Albert E. Leeds, of the Stevens Institute, Hoboken, in a paper 
in the American Journal of the Medical Sciences for June, 1891, 
has demonstrated the fact that, for all practical purposes in 
the feeding of infants, a temperature higher than 155° F. so 
changes the milk as to render some of its ingredients innutri- 
tious ; that the sugar is changed to a certain degree, and that 
the casein and fats are largely altered; that, in fact, milk 
raised to a temperature of 212° F. is not a nutritious form of 
food. Dr. E. P. Davis, of Philadelphia, as a joint writer of the 
same paper, taking his experience from hospitals and dispensary 
practice, confirms these statements, and claims that the steam 
sterilizing of milk forms a non-nutritious substance, which, 
though an admirable substitute for the tainted milk of the 
alleys in hot summer weather, is not to be recommended as a 
regular article of diet. 

Steam sterilizing also has the disadvantage that the lime- 
water cannot be put into the milk till it is cool ; nevertheless, as 
this whole matter is still under consideration, and as the weight 



STERILIZING AND STERILIZERS. 



117 



of experience seems still to be in favor of the sterilizer, our 
great test of its value is the condition of the child. If the 
infant thrives upon its bottles of steam-sterilized milk, that is 
all that is needed. 

3. The marvels of modern surgery grew out of the germi- 
cidal action of antiseptics ; but when the excitement calmed 
down, cooler minds discovered that it was asepsis — cleanliness 
— that did the work. Just so I believe that in the majority of 
cases the milk can be rendered aseptic by care and good sense 
without prolonged steam sterilization. 

Fig. 15. 




i f8 Sterilizer 





Professor Leeds has recently demonstrated that a tempera- 
ture of 155° F., prolonged for six minutes, is amply sufficient, 
and that the whole mixture can be made without the danger 
of destroying the lime-water and other ingredients by over- 
heating. You can use for this purpose a sterilizer such as 
represented in Fig. 15, made by Blair Sons, Philadelphia. 

All the small bottles can be filled with the prepared mix- 
ture, — that is, milk, cream, lime-water, sugar of milk, — or a large 
stock bottle may be used, from which a bottle can be filled at 



118 MOTHER AND CHILD. 

each nursing; for a cork, either a plug of cotton batting or a 
gum cover can be used ; the bottles should be surrounded entirely 
'by water, — a thermometer hanging in the water somewhere, 
where it can be readily seen ; there is no necessity for a cover 
in this case. You now place the sterilizer on your nursery 
lamp, the oil stove, or the kitchen range, if necessary; but an 
oil stove or lamp is much better, as the flame can be regulated 
so that the temperature of 155° F. can be maintained for about 
six minutes. Immediately after the heating is over each bottle 
should be placed in a nursery refrigerator and warmed up as 
needed, the nipple taking the place of the cotton plug or 
rubber cover. 

What are the advantages of this process ? As will be readily 
seen, the principal advantages of this method are, that we 
have a sterilized milk about whose nutritive qualities there 
can be no question, and that the entire ingredients of a child's 
bottle can be sterilized. 

What are the disadvantages ? The disadvantages are, that if 
the milk should happen to be tuberculous, — and some lay great 
stress on the necessity for precaution in that regard, — the tem- 
perature is not high enough to kill its bacilli or spores, as it 
needs a somewhat prolonged temperature of 212° F. for that 
purpose. Again, it is by no means as simple as boiling or steam 
sterilizing, and requires more care and intelligence. It is prob- 
able also that the milk will not remain sterile for any length 
of time. It is a method which should only be used when 
the milk is intended to be given to the child within twenty-four 
hours. 



HOW TO PREPARE THE BOTTLE. 119 



CHAPTEE XXX. 

HOW TO PREPARE THE BOTTLE FOR A HEALTHY BABE PROM 
BIRTH TO TWO OR THREE MONTHS OF AGE. 

One would imagine that nothing could be easier than to 
prepare a formula by which an exact imitation of mother's 
milk could be attained. We know the ingredients, and the 
question seems to be one of chemistry alone, — simply the pro- 
portions in which to mix them. And yet the matter is by 
no means settled to the satisfaction of the profession gen- 
erally. A few years ago it was practically guessed at, and the 
baby's bottle was never the same. To-day we are working it 
out on a scientific basis in the laboratory, and are now wait- 
ing for our chemists to settle amicably upon one formula, 
— not that we would always strictly adhere to it; change is 
a good thing for the digestion ; a little less cream to-day and 
a little more water if the child be fretful or constipated ; the 
omission of the lime-water if the child is very constipated, and 
the addition of cane-sugar instead of milk sugar, may now 
.and then be of advantage. 

We will endeavor to make the matter as clear as possible, 
and to give the formula for, and an account of, each method of 
preparation, so that a mother may so thoroughly understand 
the subject that she can change from one preparation to 
another if she finds it necessary, should there be no physician 
to consult. 

We now enter upon one of the most difficult subjects of 
our book; the reason of this being that it is a subject to 
which much attention is being paid at the present day, and 
the brightest talent of the profession is at work by careful 
study, in the nursery and in the laboratory, to get a perfect 
substitute for mother's milk. This has not yet been arrived 
at, though we can now produce a milk mixture which will 



120 MOTHER AND CHILD. 

agree with the average healthy babe under the ordinary cir- 
cumstances of life. But when it comes to an unfortunate 
little one who has not been born with the traditional "silver 
spoon in its mouth," and who has to withstand the vitiated, 
devitalized air of a crowded, filthy city in summer-time, there 
can -be but one opinion, and that is, it should have a wet-nurse, 
we will give a variety of directions in regard to the prepara- 
tion of the bottle, because the digestion of infants is a complex 
matter and every babe is a law unto itself, and what agrees 
with one may not agree with another. Indeed, what 
agrees with a babe one week may not the next, and the doctor 
may find it necessary to frequently change the kind of food 
to suit the child's conditions. "We have known splendidly- 
formed, healthy children result from a prolonged use of con- 
densed milk, though we would never advise its use alone for any 
length of time ; again, we have known babes whose own mother's 
milk acted upon them like poison, and who never could nurse. 

Some most excellent ways of preparing a bottle have been 
recommended, but the methods are tedious and require great 
skill and patience and often certain apparatus that mothers 
cannot get, and therefore a simpler method, which may not 
be quite as good but almost so, has to be adopted. For 
instance, the word sterilize has a very formidable sound and 
seems wonderfully scientific, smacks of the laboratory, etc. 
It really means a destruction of the germs of fermentation 
and disease, and a temperature of 155° F. will do this, and 
if the air is excluded the milk will remain pure. But if the 
milk must be sterile, so must the water that is put into it, the 
cream, the sugar, the lime-water; the bottle must be clean 
also, and the nipple, and they must be kept so. Now, it is a 
difficult and very tedious matter to keep each of these articles 
sterile separately, and on that account the bottle of milk, 
when prepared for the babe, is sterilized in bulk, as we shall see 
later. 

It must be remembered that cold will not sterilize : it checks 
germ-growth and development; but once warm up the 



HOW TO PREPARE THE BOTTLE. 121 

material and the germs return to life. Freezing will not kill 
the typhoid -fever germ : it will be preserved in ice, and when 
that ice melts it will regain its activity. So if you put milk 
on the ice you only put such germs as are in it to sleep, and 
when the bottle- is warmed or the heat of the child's stomach 
and intestines warms the milk, the germs of diarrhoea become 
very active. Cold milk keeps sweet because the germs of 
fermentation and putrefaction are made torpid ; that is why 
milk is put on the ice when fresh. Milk can be made sterile 
in the morning, and corked air-tight, and the great Pasteur 
has taught us that a plug of cotton batting as a cork is im- 
pervious to germs; indeed, it is the exclusion of germs, not 
air, that we want, and this milk (or prepared food) need not, if 
so kept, be sterilized again as each bottle for feeding is drawn 
off. But the cotton batting must have been previously laid 
for a few moments in the hot oven to sterilize it. 

There is very little trouble about rendering a babe's bottle of 
milk sterile ; every house has a stove or range, every kitchen 
has a wash-boiler, ordinary bottles are easily obtained, and a 
thermometer is not an expensive article ; these, with a few 
rubber thumb-stalls that will fit over the bottles, or some cot- 
ton batting, will complete all the requirements for the most 
perfect sterilization. Of this we will speak later; suffice it to 
say that no babe should be allowed to take a bottle of milk 
that is not sterilized. 

The following method of preparation of the bottle has been 
suggested by Dr. A. Y. Meigs, and though it is somewhat 
more complicated, makes a food much like mother's milk, 
according to Dr. Meigs's analyses: 

Order from a druggist a number of packages of sugar of milk, 
each containing seventeen and three-fourths drachms ; dissolve 
one of these packages in a pint of water each day. Take 
three tablespoonfuls of this sugar-water, two tablespoonfuls 
of ordinary cream, one tablespoonful of milk, two tablespoon- 
fuls of lime-water. Put in nursing-bottle, to be taken warm. 
, Dr. T. M. Eotch has modified this according to the careful 

F 11 



122 MOTHER AND CHILD. 

studies of himself and Dr. Harrington, and gives us the follow- 
ing method. He concludes that there is too much lime-water 
in the above mixture ; that one-quarter of the amount would 
give sufficient alkaline reaction and make it more closely re- 
semble mother's milk, the proportions necessary being one- 
half ounce (a tablespoonful) to the half-pint of the mixture, 
or, in other words, one-sixteenth part of the whole. 

He has a measure made of tin or wood that will exactly 
hold three and three-eighths drachms of sugar of milk, and he 
advises the mother to buy the sugar of milk by the pound. It 
is well to prepare each morning, or morning and evening if 
fresh milk comes twice a day, sufficient food to last. 

Cream (twenty per cent, fat), one ounce and a half; 
Milk, one ounce ; 
Water, five ounces ; 
Milk-sugar, one measure. Mix. 

A glass graduate should be used for this purpose. This 
mixture should be introduced into a clean bottle by means of 
a funnel, so that the neck of the bottle be kept dry. The 
bottle is stoppered tightly with a cotton plug. After steaming 
for twenty minutes, remove the bottle and allow it to cool 
slightly, and then add half an ounce of lime-water. Place 
on ice. 

As lime-water figures so largely in the bottle-feeding of 
babes, we will here quote the method of its preparation from 
the United States Pharmacopoeia (sixth edition). 

LIQUOR CALCIS. 

It contains about .15 per cent, of hydrate of calcium. 
" Slake the lime by the gradual additions of six parts of 
water, then add thirty parts of water, and stir occasionally 
during half an hour. Allow the mixture to settle, decant the 
liquid, and throw it away. Then add to the residue three hun- 
dred parts of distilled water, stir well, wait a short time for 



HOW TO PREPARE THE BOTTLE. 123 

the coarser particles to subside, and pour the liquid holding 
the undissolved lime in suspension into a glass-stoppered 
bottle. Pour off the clear liquid when wanted for use. 
When heated to boiling it becomes cloudy, and is then probably 
valueless" 

Remarks. — To make this matter clear and more practical we 
will suggest the following, based upon the above: Take a 
piece of clean unslaked lime about the size of a hen's egg, 
put it into a clean preserving jar, and add six tablespoonfuls 
or, if you have a graduated glass (this and a funnel you 
should by all means have), three ounces of water. This will 
effervesce slightly, and generally heat in so doing. In a few 
moments add thirty tablespoonfuls or fifteen ounces of water, and 
stir with a glass rod occasionally for half an hour. Now lei 
this mixture settle ; in the course of an hour or two decant 
the liquid and add to the lime in the bottom about one gallon 
of water that has been previously boiled and cooled. When 
this has settled so far as the larger particles of lime are con- 
cerned, pour it into a clean, glass-stoppered, gallon bottle, and 
keep in a moderately cool place while using. 

Mothers often want to know the apothecary's measurements : 

One drachm equals about sixty grains, — about sixty minims, 
about one hundred and twenty drops of alcohol (a little less 
of water), — and is represented by a teaspoon. 

One-half ounce equals four drachms, — two hundred and forty 
grains, two hundred and forty minims, four hundred and eighty 
drops, — and is represented by the tablespoon. 

Thirty-two tablespoonfuls liquid measure make about a pint, 
and though a pint is equivalent to a pound, a level tablespoon- 
ful of a light powder will be equal to only the half of a level 
tablespoonful of a liquid. 

This shows the great uncertainty attached to the use of 
spoons in measuring, and we hope the readers of this book will 
only use glass graduates in future. 

The milk from an ordinary dairy should be obtained as fresh 
as possible : mix together half a pint of this milk and half a 



124 MOTHER AND CHILD. 

pint of pure water, and to this should be added about two 
hundred grains or two heaping teaspoonfuls of milk-sugar 
with four grains of bicarbonate of soda, after which two table- 
spoonfuls of cream should be stirred in, and it is ready for use, 
to be given by bottle or drinking-cup, at about the body tem- 
perature. 

We have here a mixture which, according to Leeds, closely 
resembles mother's milk. This should, of course, be rendered 
sterile. 

We have always, in practice, adhered to the rule that the 
nearer we could approach to nature's standard the more fortu- 
nate we would be in our results in baby-feeding. Thus, the 
fresher the milk the better; that directly from the cow the 
best of all; the less we altered it by cooking and extras the 
more easily assimilated it would be. The feeding of a healthy 
babe and that of a delicate one are matters totally different, 
and we are now considering the feeding of the healthy one. 
Moreover, we have always attempted the simplest measure 
first, and then gradually felt our way by changing the prepa- 
ration of the food until we succeeded in finding that which 
suited the individual case. On this account we have given a 
variety of suggestions, so that a doctor or a mother may never 
be at a loss what to "try next," for it is a question of trial, and 
he who has the most resources at his command makes the 
greatest success of it. 

Our first attempt at bottle-feeding, when we have to aban- 
don mother and wet-nurse, is to use fresh milk and scald it; 
order, for instance, a half-pint of medium (unskimmed) milk, and 
this is better obtained direct from the cow or dairy ; to this add 
two teaspoonfuls, heaping, of milk-sugar and two tablesjpoonfuls 
of lime-water, and then pour upon it a half-pint of boiling water. 
This is then tightly corked and kept on the ice, and a portion 
withdrawn for each bottle and the bottle immersed in hot water 
until the milk reaches about blood-heat (98° to 100° R). If 
it be possible to obtain the cow's milk oftener than twice a day, 
so much the better: it will make fresher food ; but it should be 



HOW TO PREPARE THE BOTTLE. 125 

obtained twice, morning and evening, at least. A slight pinch 
of salt is a useful addition to this mixture. Dr. A. Jacobi 
dwells at length on the great importance of salt in the diet of 
the nursing mother, or in the bottle of a hand-fed infant. 
" The quantity of salt in woman's milk is influenced greatly 
by the direct addition of the same to the food. These facts 
are of great importance in the preparation of an artificial diet, 
whether of vegetables or of animal milk, designed for the 
human infant. The addition of salt is not only of great 
physiological importance, in the interest of tissue changes in 
general, but without such addition artificial diet is deprived, 
from the beginning, of the chemical mixture which renders it 
quite similar in this respect to the natural. An extremely im- 
portant fact is also this, that the addition of chloride of sodium 
[salt] delays and renders difficult the firm curdling of the 
milk by rennet. Thus, it ought to be added to cow's milk as 
a general rule, and to woman's milk when the large curds 
brought up by vomiting, or excavated by rectum, exhibit an 
undue amount of coagulation." Watch the passages; if they 
are curdled, and the child has colic, the food does not agree, 
and must be changed, as, if persisted in, it will set up a ca- 
tarrh and cause trouble. In this case we would try the fol- 
lowing : 

For new-born children, or those a month or two old, we may 
diminish the amount of casein and increase the amount of 
sugar by the following means: Take one ounce of ordinary 
milk and three ounces of water; add one ounce of ordinary 
cream and about a level teaspoonful and a half (eighty grains) 
of milk-sugar. Indeed, it is better to run the risk of making 
a mixture with too little casein than with too much, gradu- 
ally increasing the strength of the milk by diminishing the 
water. 

Or we may dilute the milk as follows : 

If to a mixture composed of one ounce of ordinary milk and 
three ounces of water we add one ounce of ordinary cream 
(about fourteen and a half per cent, of butter) and about eighty 

11* 



126 MOTHER AND CHILD. 

grains of sugar of milk (a level teaspoonful and a half), 1 we 
will get a result which closely resembles woman's milk, though 
containing less casein and more sugar than most authorities 
give as the result of their investigation. Still, for very young 
infants this is an advantage. As the babe grows older the 
amount of casein can be increased as follows : 

Take two ounces of ordinary fresh milk, add two ounces of 
water. Now add two tablespoonfuls of ordinary cream of 
good quality and a heaping teaspoonful (about one hundred 
grains) of milk-sugar. Cream itself contains about three per 
cent, of casein. But we have insisted that there must be a 
certain amount of lime added to the mixture, and for this 
purpose lime-water can be used, a tablespoonful to the bottle 
replacing one of water. As we bave before suggested, if there 
is the least doubt about the keeping of milk it should be im- 
mediately brought to a boil and then placed in the refrigerator, 
a certain amount being withdrawn and heated over for each 
bottle. Under no circumstances should a bottle of made food 
be heated again. — that is to say, what remains over after the 
child is nursed should be thrown away. It can readily be 
understood why this is the case when we consider that as the 
child draws milk from the bottle the air which replaces the 
milk is that exhaled by the child, and acts most quickly as a 
putrefacient. 

The milk should be given to the child at about the tempera- 
ture of the body or a little warmer, — that is to say, about as hot 
as can be borne in the mouth, — a temperature of 100° F. Each 
bottle should be tasted, to see that there is nothing wrong 
with it and also to see that it draws well through the nipple. 
A black rubber nipple is certainly the best to use, and there 
should be a number of them, so that a clean one which has 

1 A silver teaspoon, such as is in ordinary use, when filled with sugar of milk 
and " levelled," will contain about fifty-seven grains ; a plated teaspoon con- 
tains about five grains less, — practically one drachm. A "heaping" silver 
teaspoon holds about one hundred and seventeen grains of sugar of milk, 
— practically two drachms. 



HO W TO PREPARE THE BOTTLE. 127 

been well washed may be used each time. After a child has 
taken its bottle, if it is drowsy, it should be laid gently on its 
right side and allowed to sleep. The clothes should be thor- 
oughly loosened, and under no circumstances should it be 
allowed immediately after taking its food to be tossed or 
romped with, which, unfortunately, is a very common practice 
and always ends in indigestion. 

To some children lime-water seems to be objectionable, and 
on that account it may be necessary to neutralize the milk 
with another alkali ; and then, again, it would seem more con- 
venient and accurate to have the lime or soda, or whatever is 
used, and the sugar of milk, in a form that could be kept by 
mothers and readily introduced into the milk. For this pur- 
pose we suggested {Medical News, June 5, 1886) the following 
powder made into tablets, each one containing — 

Sugar of milk, 26 grains ; 
Calcis lactophos., £ grain ; 
Calcis carb., T ^ grain ; 
Sodii bicarb. , J grain ; 
Potass, bicarb., T \ grain ; 
Sodii chloridi, £ grain. 

These can be made up in large quantities, put in wide- 
mouthed bottles, and used as follows : 

To prepare the bottle for a child about a month old or 
younger, take one ounce of ordinary fresh milk, one ounce of 
ordinary fresh cream, three ounces of boiling water, and add 
three tablets and thoroughly dissolve. If curds appear in the 
passages, diminish the milk and add water in its place. It is 
not intended that this whole quantity should be fed to a babe ; 
a child at this age should not take more than two ounces at 
the most at each feeding. 

For a child two or three months old, prepare the bottle as 
follows : 

Take two ounces of good, fresh, ordinary milk, one ounce of 
fresh, ordinary cream, add to this two ounces of boiling water, 
and dissolve into the mixture four tablets. 



128 MOTHER AND CHILD. 

The material can be put up in cans in powder form with a 
measure holding the quantity that would equal a tablet, and 
this used in the preparation of the bottle. It needs no addi- 
tional lime-water. 



CHAPTEK XXXI. 

HOW TO PREPARE THE BOTTLE FOR A DELICATE BABE FROM 
BIRTH TO THREE MONTHS OF AGE. 

In the last chapter we considered the various methods that 
might be adopted to prepare the food of a healthy new-born 
babe ; but enfeeblement of the digestive apparatus, otherwise 
dyspepsia, is so common in infants that we are often taxed to 
our wit's end when we are obliged to bottle-feed them. 

So far we have spoken entirely of cow's milk as a substitute 
for that of the breast; but, as has been heretofore noted, the 
tendency in cow's milk is to the formation of curds that are 
compact and indigestible, and, though this can be to a certain 
extent obviated by diluting the milk as recommended, there 
are times when, owing to the difficulty in obtaining the pure 
cow's milk, which is primarily essential, or owing to the deli- 
cate digestion of the child, cow's milk seems to be indigestible. 
We are then obliged to have recourse to some process that will 
render the milk more digestible, and for this purpose various 
means have been adopted to make up a child's bottle. 

The simplest means of all would probably be to use whey only 
for the first few weeks of life, and, indeed, in many cases this 
would suffice, as Professor Leeds tells us that the nutritious 
albuminoids remain in the whey after the curd has been re- 
moved by rennet. The milk is warmed and a tablespoonful 
of liquid rennet is used to the pint of milk. The milk will 
turn if undisturbed, and when the separation has entirely 
taken place the whey can be strained off. We have frequently 
found a mixture of two tablespoonfuls of whey, one table- 



HOW TO PREPARE THE BOTTLE. 129 

spoonful of cream, and two tablespoonfuls of boiling water an 
excellent thing for a new-born babe, especially if curds have 
been noticed in the passages after a more complete milk diet. 

Eustace Smith, for years the pre-eminent authority in Eng- 
land on these subjects, has used the following as bottle-food for 
babes deprived of breast-milk : 

One tablespoonful of fresh cream ; 
Two tablespoonfuls of whey ; 
Two tablespoonfuls of hot water. 

The whey can easily be prepared in the morning and placed 
in a clean, well-stoppered bottle on the ice and used during the 
day. We have frequently advised the mother, if she is obliged 
to care for her babe at night, to place the child in a crib be- 
side her, and to take to bed with her sufficient bottles filled 
with whatever preparation is used, well corked and wrapped 
in flannel. If the food has been sterilized at a temperature 
of 155° F., and the bottles well corked, they will keep perfectly 
well, and all she has to do is to slip a clean nipple over the 
bottle in place of the stopper, and the warmth given by the 
flannel will be sufficient to heat the food. She will thus avoid 
the danger of catching cold and the annoyance of preparing 
food so often. As will be seen hereafter, the curd or casein 
of cow's milk is the great obstacle to its use generally, and 
especially with delicate babes. On this account we have always 
found it advisable not to persist in the administration of 
milk if curds are found in the passages, or in case of diarrhoea 
with greenish and watery evacuations. We would advise that 
the babe be at once placed on the following until a physician is 
consulted : 

Whey, two tablespoonfuls ; 

Albumen water or acacia water, two tablespoonfuls ; 

Sugar of milk, level teaspoonful. 

The albumen water — a preparation we have the greatest con- 
fidence in as a substitute for milk with sick children — is made 
by dissolving the white of a fresh egg in a tumbler of water. 



130 MOTHER AND CHILD. 

The acacia water, which is slightly astringent, is made by 
dissolving a teaspoonful of powdered gum acacia in a tumbler 
of boiling water. If the babe is weak, and it becomes neces- 
sary to feed often and in small quantities, ten drops of wine 
of pepsin can be added to each bottle. 

After the child's digestion has become more tolerant, — in- 
deed, in many cases of infants deprived of the breast without 
having recourse to anything else, — peptogenic milk powder 
(Fairchild) may be used and the curd predigested. There 
are cases that seem to resist all forms of bottle-feeding, and 
whose lives are saved alone by the wet-nurse ; again, there are 
hundreds of babes with good digestion who will thrive on plain 
cow's milk even undiluted with water. If a babe will digest 
fresh cow's milk, it is the best food of all. 

The following are the directions for using the peptogenic 
milk powder : 

DIRECTIONS FOR " HUMANIZED MILK." 

No. 1. For the Daily Food of a Healthy Nursing Infant.— 
Put into a clean agate-ware or porcelain-lined saucepan four 
small measures, 1 or one large measure, of the peptogenic powder, 
a half-pint of cold water, a half-pint of cold, fresh milk, and four 
tablespoonfuls of cream. Place the saucepan on a hot range 
or gas stove and heat, with constant stirring, until the mixture 
boils. The heat should be so applied as to make the milk boil in 
ten minutes. 

Keep in a clean, well-corked bottle in a cold place. "When 
needed, shake the bottle and pour out the desired portion and 
heat to the proper degree for feeding, — lukewarm. 

No. 2. Specially-prepared Food for Infants with Feeble Diges- 
tion or xohen suffering from Disordered Stomach and Bowels. — Put 
into a clean bottle four small measures, or one large measure, 



1 Each can of peptogenic milk powder contains a large and a small 
measure. Put the powder into the measure with the blade of a knife, 
shaking it down firmly so as to well and evenly fill the measure. 



HOW TO PREPARE THE BOTTLE. 131 

of the peptogenic powder, a half-pint of cold water, a half-pint 
of cold, fresh milk, and four tablespoon fuls of cream. Shake 
well, place the bottle in a pail or tin kettle of water (at least 
a gallon) as hot as can be borne by the whole hand (115° F.), 
and keep the- bottle there for exactly thirty minutes. Then 
pour all into a saucepan and quickly heat to the boiling-point, 
with constant stirring. 

Keep and feed in the same way as directed in No. 1. 

If it is absolutely necessary to use condensed milk, one 
part of pure, unsweetened milk should be first mixed with 
from two and a half to three parts of water, and it may then be 
presumed to be equivalent to cow's milk. Then to eight 
ounces of this mixture add eight ounces of water and the 
cream and peptogenic milk powder in the usual manner. In 
other words, we first require to dilute pure, unsweetened con- 
densed milk with about seven parts of water, and to each 
pint of this diluted milk should be added four tablespoonfuls 
of cream and one large measure of the peptogenic powder, 
and treated in the usual manner. 

In this connection Dr. Leeds writes to us as follows : 

" I know of no process that secures these advantages, except 
that I have so constantly recommended and now am using 
without seeing any difference, chemically, physiologically, or 
practically, from mother's milk: four tablespoonfuls of milk, 
four tablespoonfuls of water, one tablespoon fill of cream, and 
one measure of peptogenic powder, heated for five minutes 
as directed. This (temperature is 155°) Pasteurizes; converts 
the cow's milk to a point at which it gives the reactions char- 
acteristic of the albuminoids of cow's milk, gives the same 
flocculi and has the same susceptibility to digestion, and insures 
and secures the essential mineral constituents. In short, this 
process secures the advantages of Pasteurization and of a 
proper degree of contact with the ferment at one and the 
same time, and renders cow's milk both innocent and whole- 
some for infants." 



132 MOTHER AND CHILD. 

CHAPTEE XXXII. 

CONDENSED MILK. 

This brings us to the subject of condensed milk. A reliable 
brand, such as Borden's or Canfield's, has the following advan 
tages : When diluted with about ten parts of water, it repre- 
sents mother's milk pretty closely, with the exception that 
there is less cream, but to a pint of this mixture four table- 
spoonfuls can readily be added. It is absolutely necessary that 
cream should be added to a mixture of condensed milk, and 
when made the whole mixture sterilized at 155° F. The evap- 
oration of the milk in its preparation has destroyed its tendency 
to fermentation to a great extent. This most certainly is a 
great advantage. It will coagulate in flakes, and does not 
require the addition of any sugar, as by analysis it is shown 
that when the mixture is thus prepared the amount of sugar 
it contains is about equal to that in mothers milk. It can be 
universally obtained, and is useful on that score ; its disadvan- 
tage in many instances is due to the cane-sugar, and some 
object to it on the ground that it is supposed in many cases to 
lead to rickets. Our own experience does not bear this out, 
though certainly if we were to find that a child fed on condensed 
milk showed undue acidity, either in its stools or ill its breath, 
due to the presence of lactic acid, we would at once change its 
diet. 

In summer weather the presence of cane-sugar, which is a 
decided laxative, is objectionable, and herein exists the great 
difficulty in the proper selection of a food for that season. 

Dr. A. Jacobi does not believe that sugar of milk is better 
than ordinary cane-sugar, and he writes as follows : 

" The conversion of milk-sugar into lactic acid takes place 
very rapidly. When this change occurs in cow's milk, it be- 
comes sour at once. Cane-sugar is not so easily transformed. 



CONDENSED MILK. 133 

Indeed, cane-sugar is utilized for the purpose of counteracting 
the rapid conversion of milk-sugar, and the preservation of 
articles of food in general. 

" Condensed milk remains intact a long time, on account of 
the addition of cane-sugar, in spite of the presence of milk- 
sugar. Therefore, it is not at all an indifferent matter, whether 
milk-sugar or cane-sugar is added to the artificial diet. Still, the 
use of the milk-sugar has been urged upon other grounds. It 
has been stated that milk-sugar is to be preferred because it 
contains phosphatic salts, but verily these may be introduced 
into the body in other and less dangerous ways. Besides, it 
will be proven in another part of this book, that phosphates 
are so plentiful in all kinds of foods that they are eliminated 
as fast as they are introduced. It has also been said that 
milk-sugar is contained in milk by virtue of a natural arrange- 
ment, and if nature had intended to have cane-sugar in milk, 
the same nature would have supplied cane-sugar. After all, it 
is a fact, and often a disagreeable one, that milk-sugar is 
quickly converted into lactic acid, so that an excess of acid 
accumulates in the stomach and causes the protein substances 
to coagulate and become indigestible; it dissolves the alkalies 
and the calcium out of the phosphate combinations to no pur- 
pose except to produce dyspepsia and diarrhoea ; it eliminates 
phosphoric acid before the proj)er time, and gives rise again 
to diarrhoea, and, according to Heitzmann and others, to 
rhachitis. These facts furnish reason enough for carefully 
avoiding the use of milk-sugar, and for preferring cane-sugar as 
an addition to cow's milk and artificial foods. 

'• In accordance with what has been said, I assert that arti- 
ficial nutriments for children ought to be mixed with cane- 
sugar, not with milk-sugar, in view of the active production of 
acids in the young, their tendency to diarrhoea, and the danger 
incurred by the premature discharge of salts." 

Let us study for a moment the question of the " fresh evapo- 
rated milk," which offers for the future the best field for infant- 
feeding in those cities where it is daily supplied, especially in 

12 



134 MOTHER AND CHILD. 

summer-time, and where the dairy milk, as served, is of doubt- 
ful character. We may add to one part of it seven parts of 
water previously boiled or filtered. 

We find that it will be necessary to add to the half-pint of 
the above mixture of evaporated milk two tablespoon fuls of 
cream and two heaping teaspoonfuls of sugar of milk. This 
will be equal to cows' milk, with about the same percentage of 
casein as mother's milk. The absence of cane-sugar in this 
preparation renders it valuable in summer in our large cities, 
when diarrhoea is prevalent. Indeed, in such cases half an 
ounce of this milk in a graduated glass with four ounces of 
water, previously boiled and filtered, given at the temperature 
of the body, about 99° F., without adding cream or sugar, 
would in many cases be a most suitable diet. If the bowels are 
loose, lime-water could be used. Unquestionably, disorders of 
the intestinal tract are produced by fermentation and also by 
mechanical irritation of undigested cards, and this is often due, 
not alone to the method of preparing the food, but also to the 
deficient supply of the gastric juices. If a large supply of 
gastric juice could be encouraged, both of these causes would 
cease to exist, as the acid mixture is antiputrefactive as well 
as digestive. We are often obliged to use some means to pre- 
pare the milk and destroy its ferments, and to diminish its 
casein, or so affect it as to allow precipitation in fine masses. 
The former is readily accomplished by boiling, or by subjecting 
the milk to heated steam ; the latter by several means now in 
vogue. 

The first, by rendering the milk alkaline, which retards in a 
measure the coagulating property of the gastric juice. 

The second^ by diluting the milk with water, which diminishes 
the percentage of casein. 

The third, by thoroughly incorporating with it some material, , 
such as gelatin, or a small amount of starchy matter, such as 
oatmeal-water, barley-water, rice-water, or arrow-root, that 
will intimately incorporate itself in the casein as it falls, and 
thus allow the gastric juice to completely attack it. 



CONDENSED MILK. 135 

The fourth^ by partially predigesting the casein — peptonizing 
it, as it is called — before it enters the stomach. 

We have, in addition to these, various other preparations, 
which are sometimes added to the milk to render it more 
nutritious ; for example, soluble carbo-hydrates, the so-called 
"Liebig foods," as dextrin, glucose, or substances rich in albu- 
minous matters. This, in fact, covers the whole ground of the 
various preparations used in the bottle-feeding of infants, and 
3-011 will thus see that they all have some scientific basis to 
work upon, and their choice depends on questions of expediency 
and reliability, which should be studied in connection with each 
particular case. 

Cow's milk can readily be rendered alkaline by the addition 
of lime-water, soda, or potash, and the curd affected thereby. 
We think the importance of alkalinity is somewhat overesti- 
mated, — that is, the tendency seems to be to put too much soda 
in the milk ; all that is required is to make it neutral, even for 
peptonizing purposes. 

When lime-water is added to the bottle, one tablespoonful 
to a half-pint mixture will be in most cases sufficient. It is 
always well to consult a physician before lime or soda is 
added to the bottle of milk ; there may be reasons why a choice 
should be made between the two. Indeed, too much alkali 
may weaken the digestive organs and make the child flatulent 
and dyspeptic. Yichy or Manitou water is a very good addition 
to milk instead of lime-water; if the child should continue to 
pass curds, it should be used in the same strength as lime-water. 
Dilution with water is a very important matter, because by 
weakening the milk with the object of diluting the curd we 
also diminish the fat or cream, the sugar and salts. Now, as 
all of these are essential to nutrition, it is obvious that by 
diluting them we are obliged to give the child greater bulk 
than it would otherwise take, and to overcome this difficulty it 
is necessary to add cream, sugar, and salts to the bottle in its 
preparation. The question of the digestion of fat is a very im- 
portant one. The fats and sugars serve pretty much the same 



136 MOTHER AND CHILD. 

purpose in the system : they are the so-called carbo-hydrates, 
and go to the formation of animal heat. But the fats serve 
even a greater purpose : they are found essential to nutrition ; 
they give strength, and act in that way the same as the curd 
or nitrogenous principle. Fat is in greatest demand at the time 
when animal heat is the most required, — that is, during the 
winter months ; the fats and soluble carbo-hydrates, when sup- 
plied in excess, are stored for future use ; their excess in hot 
seasons is productive of intestinal disorders. In such cases a 
change to soups, or albuminous water, made by dissolving the 
white of egg in water, makes a nutritious diet and is a valuable 
change. The oils, when stored, give a condition of body which 
is firm and elastic to the touch, and when this reserve is called 
upon the emaciation is gradual. On the contrary, when the 
storage takes place from excess of sugar fat, the fat is not 
staying and its disappearance is sudden. This is well seen in 
children fattened on condensed milk to which no cream has 
been added. 

Lessen, then, the amount of cream and sugar for the summer 
season and increase the nitrogenous elements. 

The question so often arises as to the exact value of condensed 
milk and the cases in which it may be used, that we may well 
be pardoned if we again dwell upon it for a few moments. The 
heat which is used in making it has destroyed the germs of 
putrefaction and thereby helped to preserve it. This is a very 
great gain. Then, also, the statement that only fresh, sweet 
milk can be condensed is undoubtedly true, as the odor which 
arises from stale milk would at once expose its character. 
But in all probability the heat which has driven off the water 
has acted in the same manner as the heat in the steam sterili- 
zation : it has deprived the milk of some of its nutritious quali- 
ties, and as a regular article of diet, to be depended upon alone 
for nutrition, it is not to be recommended. The soft, floccu- 
lent masses into which it is coagulated are of immense advan- 
tage, especially in young infants ; it is the nearest approach to 
mother's milk. The only question which is at all worthy of 



CONDENSED MILK. 137 

consideration is that of the sugar which it contains and the 
deficiency of cream, when the mixture is diluted, compared 
with that of mother's milk. For instance, a bottle made up 
of an ounce of condensed milk (mothers and nurses should 
use a large graduated measure in preparing babies' bottles) with 
ten ounces of water is almost identical in its composition to 
mother's milk, with the exception that it contains cane-sugar 
instead of sugar of milk, and has less cream. For a very 
young infant, one who has been suddenly deprived of breast- 
milk, a mixture of this kind probably possesses greater ad- 
vantages than any other milk food, and we feel satisfied that 
it will agree better and can be more easily prepared than 
any other bottle. The water should be previously boiled and 
filtered, the can kept in a cold place, well covered, and each 
bottle made up fresh. We would even prefer this form of 
condensed milk to the evaporated fresh milk, which has no 
sugar, for a very young infant, unless it is previously under- 
stood that to the freshly-evaporated milk sugar of milk should 
be added to each bottle. 

In order to be on the safe side, even this mixture should be 
sterilized at 155° F., as the milk is liable to contamination after 
the can is opened. Let us, then, be distinctly understood as 
recommending condensed milk, not as a regular article of diet, 
but simply to be used to bridge over that most delicate period 
in a child's existence when it is deprived, at an early age, of 
breast-milk, and when there are doubts as regards the character 
of the cow's milk from which its food is to be made. It will 
carry the child safely over a change in the character of its 
food, which is all- important ; it also has the advantages of being 
always at hand, and when obtained fresh and from reliable 
sources is usually of about the same quality. We have seen 
children a year or more old brought up entirely on condensed 
milk, with every appearance of health and strength, and they 
are unusually fat children, as a rule, but at the same time we 
would not advise it. There is no necessity for this, as most 
certainly by the time a child is five or six months old it can 

12* 



138 MOTHER AND CHILD. 

easily digest one of the preparations hereafter recommended, 
containing cow's milk boiled with oatmeal or barley. 

Of course, as a child grows older its digestion becomes 
stronger: it becomes, in fact, accustomed to its food. A 
change can be made by adding cream to each bottle in the 
proportion before recommended, — that is, to a half-pint of the 
condensed milk, as prepared above, an ounce of ordinary cream 
may be added. If one lives in the country and milk can be 
obtained warm, fresh from the cow, it should be used instead 
of condensed milk ; but we would not recommend a city child 
to be given, shortly after its birth, ordinary cow's milk and 
water, such as is supplied by the ordinary milkman. 



CHAPTEE XXXIII. 

PREPARED BOTTLE. 

The question of the curd commands the most serious atten- 
tion. This curd is always in the way, although it is an im- 
portant article of diet, being a muscle-forming element ; and 
yet it is not the most important by any means to the young 
infant, as nature has shown by supplying so little to the 
human milk compared with that of the cow. We must either 
get rid of this curd entirely for children who are suffering 
from disease or indigestion, or we have to so act upon it as 
to make it either coagulate in nocculi, or to digest it in the 
bottle, as has been done in the process called peptonizing. 

The whey food, or a mixture of cream and hot water, gives us 
a preparation without the curd at all, or, as in the latter, very 
little of it, so that children with the weakest digestion can 
probably live comfortably and thrive on such food; but of 
course when it comes to growth and development, requiring 
active muscular exercise, a stronger food is needed, and casein, 
or curd, becomes a necessity. We will quote here, for the in- 



PREPARED BOTTLE. 139 

formation of those who are interested in the subject of di- 
gestion, a portion of a paper read by one of us. 1 

" Digestion is not merely a process of disintegration ; certain 
secretions are requisite to bring about the chemical changes 
required. What are these secretions? First, we have that 
from the salivary glands which changes starch into sugar. 
The saliva secreted by a child under six months is at a mini- 
mum ; very little' is required, simply enough to lubricate ; but 
I may say that in a series of experiments I have recorded a 
child of seven days who secreted saliva which possessed suffi- 
cient diastase to convert the boiled starch used into grape- 
sugar. This readily accounts for those infants who fatten 
on corn-starch, much to the surprise of the family medical 
attendant. 

"As the child grows and teething begins, quite a large 
amount of saliva is secreted, and undoubtedly the activity of 
this secretion forms a prominent part in its digestive process ; 
in other words, a child that slobbers, as a rule, has little diges- 
tive disturbance. 

" The curd is precipitated and turned into peptones, or albu- 
minose. All albuminous matter is so converted, and a burden 
by no means light is placed upon the liver, — an organ more 
prominent in infancy than in adult life. 

" The precipitation of the casein presents some curious 
features; indeed, this matter is of fundamental importance 
in our studies. Woman's milk is alkaline, it is watery, its 
curd is precipitated in soft flakes. Cow's milk is slightly 
acid, its curd forms in firm, hard masses of cheesy consist- 
ence. The curd in all cud-chewing animals, of which the 
cow represents the class, is thrown down in masses so as 
to be readily regurgitated by the calf for the purpose of tritu- 
ration. In the non-cud-chewers the reverse is the rule. 
There may be other peculiarities of the curd, — chemical differ- 
ences, — but these have not as yet been determined." 

1 Keating, Annals of Hygiene. 



140 MOTHER AND CHILD. 

Dr. E. P. Davis writes, " These results of investigation, com- 
bined with the clinical study of infantile digestion and its 
disorders, warrant the inference that in the digestion of the 
infant hydrochloric and lactic acids do not normally exist; 
that milk is clotted by a rennet ferment active in alkaline or 
neutral media ; that the stomach serves the purpose of a co- 
agulating bottle which is empty in less than an hour after 
feeding; that digestion and absorption proceed according to 
the activity of the pancreatic and intestinal secretions, the 
pancreas being especially concerned in normal digestion, and 
the lack of its functional activity being most apparent in 
gastro-intestinal disease." 

The secretion from the pancreas is the next and last of im- 
portance. It is composed principally of two materials; in 
fact, a third may be added, the curdling principle ; these will 
act in an alkaline or faintly-acid solution : the first a material 
analogous to the pepsin of gastric juice, which converts casein, 
or other albuminous matters, into peptones, and substances 
that have escaped the action of the gastric juice ; and a diastase 
like that of the saliva, which converts starchy matters and 
cane-sugar into dextrin or grape-sugar. 

To the infant the gastric juice is the most important of its 
secretions ; only such food as contains albuminous matter with 
soluble carbo-hydrates, as glucose and oil in emulsion, should 
be given ; such, indeed, is milk. 

We have, then, two matters to consider in the artificial 
feeding of infants, and we shall limit ourselves to those within 
the first year : one, the preparation of a food containing the 
elements of mother's milk, in a combination as much like it 
as possible ; and the other, no less important, the elaboration 
of those secretions which digest it. An equal balance must 
be maintained between the two. 

The coagulation of the casein of cow's milk into hard masses 
can be prevented by certain means ; one of the most impor- 
tant of them is diluting with water. It is for this purpose that 
water is added to cow's milk ; but it has also been noted that 



PREPARED BOTTLE. 141 

if certain materials which are not digested in the stomach are 
allowed to become thoroughly mixed with the milk, they will, 
acting in that way, so honey-comb the curd, as it were, as to 
prevent its forming a solid lump of cheese. Lime-water may 
do this, — if the -bottle is shaken there will be seen a great deal 
of lime which is not dissolved in it, — but farinaceous foods, such 
as the cereals, the starches, if they enter the stomach as such, 
are not digested there, but probably act in a measure towards 
the curd as sand does in the stomach of a bird. The cereals, 
when examined under the microscope, are found to be cov- 
ered with a material that is destroyed by heat or digested 
by the gastric juice; the starch in either case becomes free, 
and the saliva, if it comes in thorough contact with it, will 
turn it into dextrin or grape-sugar ; in that state it is carried 
to the liver. The same takes place when the pancreatic 
secretion attacks it, — that is, after the food has left ,the 
stomach; but as a child has both the saliva and the pan- 
creas secretion in but small amount, to feed it entirely on 
starchy food is simply to give it starvation diet. It cannot 
live on such material. Very fortunately fur the baby, its corn- 
starch has to be boiled, and this boiling process converts it 
into grape-sugar, or at least so nearly so as to allow the con- 
tact of the feeblest secretions to finish the work ; and* fortu- 
nately, also, nature often supplies the child with very active 
salivary glands during its teething period : it slobbers con- 
stantly, and the corn-starch food comes in contact with this 
secretion, which renders it digestible ; but the poor infant who 
is given half-boiled arrow-root, or flour, or corn-starch too 
'thick to flow readily through the bottle, and who cuts its 
teeth hard, — that is to say, has dry gums, little secretion, — 
will not be long before it shows an inflammation of the bowels 
that will be the cause of its death. 

The reader can now see why it is that some children get 
along well on corn-starch food and thrive from a very early 
age upon boiled bread and milk, cracker-dust food, or sub- 
stances of that sort; but, unfortunately, it is these very chil- 



112 MOTHER AND CHILD. 

dren who form exceptions to the rule that cause the invariable 
evil result by tempting mothers to give starchy food to two- 
thirds of the children when too young. A cereal may be added 
to the child's bottle after it is three or four months old, if it be 
deemed advisable, beginning with a very small quantity. 

The simplest and one of the best ways of preparing the 
bottle is the mixture suggested by Dr. J. F. Meigs and used 
by him for so many years with success. A two-ineh-square 
gelatin cake is soaked for a short time in half a pint of cold 
water, the water is then boiled for fifteen minutes until the 
gelatin is thoroughly dissolved, a teaspoonful of arrow-root, 
rubbed into a paste, is stirred into the boiling water, and 
then the milk added in the proportion of one-third milk and 
two-thirds water for the new-born, two-thirds milk and one- 
third water at six months, varying in proportion at the ages 
between. These are allowed to boil together for a few min- 
utes, and then for the young infant two tablespoonfuls of 
cream are added to the pint of food, and to this about six and 
a half drachms (or teaspoonfuls) of sugar of milk, or three tea- 
spoonfuls of white sugar. 

Dr. J. Lewis Smith recommends for the preparation of in- 
fants' food the following plan : Take from five to ten pounds 
of well-selected wheat flour, put this into a bag, tie firmly, 
and keep covered w r ith water for several days, possibly a 
week; this should occasionally be made to boil. In the prep- 
aration of the bottle for a child under three months, the water 
used for diluting the milk should have boiled with it some 
of this flour, grated in the proportion of two heaping tea- 
poonfuls to a pint; after the sixth month four teaspoonfuls. 

Another excellent preparation is made as follows: The 
milk is diluted with its bulk of water, which should be pre- 
viously thoroughly boiled with either ground barley, oatmeal, 
or baked flour, in the proportion of a dessertspoonful to the pint, 
the milk poured in while the water is boiling, the whole boiled 
together for from twenty minutes to a half-hour at least, and 
then strained. This may be sweetened, an ounce of cream 



PREPARED BOTTLE. 143 

added, and the whole forms an excellent food for a child after 
its fourth month. 

It being understood that a cereal such as barley, oatmeal, 
or Graham flour is not to be given to a child as the basis 
of its food, but only to slightly thicken the milk and give it 
substance, and to prevent heavy curding, the choice of the 
article is a matter for consideration in each individual case. 
Mothers ought to know that the outer portion of a grain 
of wheat, corn, or oats — in other words, the bran— acts as 
a laxative, and it is on that account the crushed grain is 
more valuable where there is a tendency to constipation. 
Next to the outer surface we have that portion of the grain 
in which resides most of the nitrogenous principle, the so- 
called gluten: so that in the debranned flour we have a prep- 
aration which is nourishing and fattening, but not laxative. 
The internal portion of the kernel of all these cereals con- 
tains the starch -granule, and this part we know gives the 
tendency towards constipation, and is least nutritious of all, 
but is the heat-forming element; thus, in the whole crushed 
grain we have all the elements necessary for health and 
nutrition. When it is desirable to use any of these cereals 
it is far better to use the whole grain, crushed, unless there 
should be looseness of the bowels or irritation of some sort, 
in which case the flour alone should be used. But mothers 
should bear in mind what we have laid stress on before, 
that whenever a starchy food is used the starch-granule should 
be thoroughly broken up by heat, either by baking or by boiling. 
This is an essential matter, and we cannot repeat it too often. 

When a mother wishes to put her child on the bottle (sup- 
posing it to be about the age of four months), and wishes to 
add something to the bottle, it is a difficult matter to know 
with what to begin. Dr. J. F. Meigs advises gelatin and 
arrow-root ; Dr. J. Lewis Smith, of New York, advocates the 
flour-ball, — that is to sa}~, flour tied in a linen rag and boiled 
for hours, then taken out, grated, and used with the milk. 
Our own preference is for barley: it is the hast constipating 



144 MOTHER AND CHILD. 

and usually agrees well, and after the child has become 
accustomed to it and the digestion is in good condition, a 
small amount of oatmeal may be added with each or every 
alternate bottle, and a variety of diet in that way insti- 
tuted. 

Now, in preparing the barley for the bottle we may either 
take the whole-grain pearl barley, and have it crushed in a 
coffee-mill, or use Eobinson's barley, which comes in packages, 
finely powdered. Of course the latter is easier manipulated 
and requires less time to prepare. Of the powdered barley, 
take ' a dessertspoonful, mix it into a smooth paste with a 
little water, and gradually stir this into a pint of boiling milk. 
If the child is under six months of age you can then add from 
one-half to one-third of water, and, stirring constantly, allow 
the mixture to boil fully twenty minutes. To this can be 
added a heaping teaspoonful of white granulated sugar and a 
pinch of salt. It should then be strained. Now, if this mixt- 
ure is put in the refrigerator at once when it is made, in the 
morning, it can be used for each bottle by warming over and 
straining. If there is much constipation, oatmeal or Graham 
flour (cracked wheat) can be used in the same way. A variety 
of oatmeal known as the Bethlehem oatmeal comes powdered 
for this purpose. It is simply a carefully-selected meal well 
ground ; any good oatmeal will do as well. Of course, if the 
coarser grain is used, the boiling process will have to be very 
much prolonged ; and in such cases, if simply the crushed 
barley, the cracked wheat, or the ordinary oatmeal is made 
use of, it will be necessary to boil it in water beforehand, say 
a heaping dessertspoonful to a quart, and the whole allowed to 
simmer until it is boiled down one-half. Then this can be 
added to the milk, stirring well, and either both boiled together 
for a few minutes, or, if the child is constipated, simply scald 
the milk by pouring the boiling water and meal into it, stir- 
ring it meanwhile, and then strain. The sugar and salt can 
be added. 

In city practice we always recommend the boiling of the 



PREPARED BOTTLE. H5 

milk for precaution's sake, and think the tendency to con- 
stipation can be overcome by giving the child occasionally a 
bottle of water, which it will readily take. It is important to 
bear in mind that the food should never be made so thick that 
it will not run through the nipple. The food should be made 
in a farina-boiler, that the milk may not become scorched. 

As we have said, the selection of food is to a certain extent 
an experiment, and therefore the child should be watched to 
see whether it exhibits any symptoms of indigestion. Begur- 
gitation of food, the souring of it in the stomach, flatulence, 
hiccough, nausea, and, finally, either constipation with great 
pain, passage of curd, undigested milk which has a disagreea- 
ble odor, white passages, or diarrhoea, are of course all evi- 
dences of indigestion, but these must not be confounded with 
the symptoms that are brought about by tight bandaging, 
jolting, dancing the child up and down after a meal, forcing 
it to take more food than it can conveniently carry or 
digest. 

We have often seen cases in which the mother blamed the 
indigestion on the diet when the food had agreed perfectly 
well, but the indigestion had been brought about by the way 
in which the child had been treated. If the child uses the 
bottle, it should not lie flat on its back, but should assume the 
same position that it occupies when nursing from its mother. 
It is well always to avoid the use of purgatives or laxatives, 
in bottle-fed children, as far as possible. Use in their stead the 
more laxative cereals. 

Eemember that water is nature's most efficient laxative, 
that when salt is added to the food it has the same excellent 
effect, and that regularity and the establishment of habit, both 
in its feeding and in the timely movement of its bowels, is of 
the greatest value to the child, Do not think the amount of 
material you put into a child's stomach is alone necessary for its 
sustenance. Do not think that because a child is given a 
quart or more of milk a day it is all that is necessary, and 
that it must thrive whether or not. This is a mistake which 
o k 13 



146 MOTHER AND CHILD. 

mothers are constantly making. It is the amount that is digested 
and absorbed that nourishes, the rest decomposes or irritates. 

This brings us to the subject of predigesting the curd. 

Professor Albert K. Leeds, of Hoboken, gives us the follow- 
ing way of preparing milk for infants : 

One gill of cow's milk, fresh, unskimmed ; 

One gill of water ; 

Two tablespoon fuls of rich cream. 

To these can be added one powder which contains two hundred 
grains of sugar of milk and four grains of bicarbonate of soda with 
a grain and a half of extract of pancreas. These powders, each 
one containing the above formula, can be made up in any 
drug store. The milk, with this powder added to it, should 
be put into a nursing-bottle, which should be placed in hot 
water — so hot that the hand cannot be held in it for more than 
a minute at a time (115° F.) — and kept there for about twenty 
minutes, and then allowed to cool sufficiently for the child to 
take. This powder is called peptogenic milk powder. 

In a lecture before the Philadelphia Hospital Nurses' Train- 
ing School, Mr. Fairchild spoke as follows : 1 

" When we speak of peptonizing food, we do not mean that 
pepsin is employed in the digestion of the food. We simply 
mean that the albuminous portion, the casein of milk, for in- 
stance, is converted into peptone. The materials used for the 
purpose are the ferments of the pancreatic juice in the form 
of a powder, — the extract of pancreas. 2 This contains several 
ferments, each of which acts on a different form of food. 
The conditions under which these ferments act are very 
simple. If, in attempting to digest milk, you add the ferment 
to the milk when it is very cold, no action will be obtained. 
Again, if it is added to very hot milk, no action will be obtained. 
The conditions under which these ferments act are similar to 
those found in the body. A good test for determining the 



1 Keported by I)r. William H. Morrison, Holmesburg, Pennsylvania. 

2 Or the " essence of pancreas," or the " liquor pancreaticus." 



PREPARED BOTTLE. 147 

temperature of the food is to taste it. If it is hotter than can 
be sipped with ease, it is too hot. If it is desired, a little ther- 
mometer may be employed to obtain the proper temperature, 
which is 100° F. 

" I shall now show you how to make peptonized milk. I 
take one of these ' peptonizing tubes,' which contains five grains 
of pancreatic extract and fifteen grains of bicarbonate of soda, 
and empty its contents into a quart bottle. To this I add a 
gill — that is, four ounces or eight tablespoon fuls — of cold water, 
and if it is for infant feeding, the water had better be previously 
boiled. Enough may be boiled in the morning to last all day. 
I next pour into the bottle a pint of milk, and shake the bottle 
well. By adding the water and milk cold, we run no risks. 
Having done this, the bottle is set into a bowl of warm water, 
which should be of such a heat that you can hold your hand 
in it for a minute ; the temperature of the milk is thus raised 
to about 100°. The milk is allowed to remain in the water for 
half an hour; it is then put upon the ice, and the digestion 
will still continue for some time, — until the milk is thoroughly 
chilled, after which no further digestive change can take 
place. 

" I have here a bottle of milk which has been digested in 
this way. I have allowed the digestion to be carried a little 
further than is usually necessary, in order that I might show 
you the properties of peptonized milk. I first take ordinary 
milk and add an acid to it. At once a mass of coagulated 
casein falls to the bottom of the glass. I treat a sample of 
peptonized milk in the same way, and there is no trace of casein. 
As I have said, it is not usually necessary to digest all the 
casein, and the directions which I have given are for average 
cases. You have to observe the effect of the milk on the 
patient's digestion. If it is assimilated readily, the proper pre- 
digestion has been secured ; but if it is necessary to digest it 
still further, the milk may be allowed to remain longer in the 
hot water. If the milk has been digested too much, and is a 
little bitter, it may be made agreeable by the addition of a little 



148 MOTHER AND CHILD. 

sugar. You will soon learn by experience how to adapt the 
process to the requirements of each case. 

"Instead of using plain water, we may take a quantity of 
starch paste, add a little pancreatic extract to it, and stir it up. 
When starch is boiled it simply swells up, but within a few min- 
utes after the addition of the pancreatic extract it becomes a 
thin liquid from the digestion of the starch, — by the pancreatic 
diastase ; this starch is now in the way of being converted into 
glucose or grape-sugar. This may be put into a bottle with 
the soda and milk, and digested in the manner just shown, and 
we shall have peptonized milk gruel. Here the nutritious 
elements of the starch are added to the milk. In using the 
peptonizing powder a little water is always used to dissolve 
it, otherwise it would be slightly curdled by the extract of 
pancreas. 

" This peptonized milk can readily be made into lemonade. 
It may strike you as rather odd to add lemon-juice to milk, but 
as the milk has been completely peptonized, it will not curdle, 
and the lemon is often desirable to make the milk pleasant. 
Eum and suuar may be added if stimulants are required, making 
a delicious punch. It may also be taken with carbonic-acid 
water, and, if thought necessary, lime-water may be added, 
although we have already added an alkali. 

" You may make a peptonized milk jelly. If you wish to 
make a jelly, it is necessary to allow the digestion to progress 
for a longer time. A pint of peptonized milk is heated to the 
boiling-point, — that is, you scald the milk. This is necessary 
to destroy the ferment. Then take three-fourths of an ounce 
of Coxe's gelatin, a tablespoonful of lemon-juice, and a couple 
of tablespoonfitls of orange-juice. When the milk is scalded 
some of the lemon- and orange-peel may be scalded with it, 
which gives a fresh flavor of the peel. The gelatin is then 
added, and wine, brandy, or St. Croix rum may also be added. 
If you do not remember to scald the milk, you will not get a 
jelly, for the extract of pancreas will not only digest the casein, 
but it will also digest the gelatin. 



PREPARED BOTTLE. 119 

" In digesting meat, take two tablespoonfuls of chicken or 
beef finely minced and boil it with a gill of water. This makes 
the meat soft and facilitates its digestion. The meat is then 
rnbbed into a fine pulp and put back into the water. You may 
now add a gill of the starch mucilage and one of the pepto- 
nizing powders. It is then set aside for two or three hours, 
and at the end of that time scalded. The peptonized soup 
may be seasoned to suit taste. The scalding is necessary to 
stop the digestion, which otherwise would go on and lead to 
but refractive changes. 

" This plan may be used with ordinary soup. Take two or 
three tablespoonfuls of the meat, barley, etc., strained from 
soup, rub it to a pulp, and add fifteen or twenty grains of pan- 
creatic extract and half a drachm of bicarbonate of soda ; add 
to a pint of the soup, and proceed as just shown. There is no 
doubt that you get artificial digestion of all the substances, 
and at the same time you have no more trouble than in making 
ordinary food. If this is strained, and gelatin added, you ob- 
tain a nice clear jelly. The peptonized milk jelly is more 
agreeable than those made with ordinary milk. 

<; In preparing peptonized milk for babies, we follow a little 
different plan. In using cow's milk we have to dilute it with 
an equal quantity of water in order to obtain the proper 
amount of casein. We have to add a small quantity of milk- 
sugar to make up for that lost by the dilution with water, 
because mother's milk contains a little more sugar than cow's 
milk. Then we have to add the alkaline salts which are found 
in human milk. Dr. Keating spoke of the acidity of cow's 
milk, and this is a point which few people properly appreciate. 
Testing this sample of milk with litmus-paper, it is found to be 
distinctly acid, and, in fact, I have never tested cow's milk 
without finding this acid reaction. Here we have a powder 
(peptogenic milk powder) which presents the proper proportion 
of milk-salts, milk-sugar, and the digestive ferment to change the 
casein into the soluble form in which the albuminoids exist in 
mother's milk. I take four ounces of milk, add the proper 



150 , MOTHER AND CHILD. 

amount of the peptogenic milk powder ; next we add four ounces 
of water and two tablespoonfuls of cream. This latter is an im- 
portant element, for mother's milk contains more fat than cow's 
milk. In this way we obtain the same proportions of the dif- 
ferent elements as are found in human milk. All that is now 
required is to heat it to the proper temperature for five or six 
minutes in order to properly modify the casein. The temper- 
ature is to be determined as in the former case by sipping or 
by the use of the thermometer. In this process, having first 
made a milk mixture which contains the right quantity of all 
the elements of mother's milk, and with its peculiar alkaline 
character, then we seek to effect just such a change of the 
casein — the \ curd' — as will present it to the infant's stomach 
in the condition fit for digestion, in such a condition that it will 
behave in the stomach just as mother's milk does, and make 
the same demand upon the natural digestive functions. If, 
however, the baby is very ill, and not even capable of digesting 
its natural food, this method allows you to digest it still further, 

" There are two other ways in which the ' humanized' milk 
may be prepared. Instead of taking the quantity of milk 
which I have done, we may take a larger quantity and a pro- 
portionately larger quantity of the other ingredients, mix them 
and keep them on ice. There will be no action as long as the 
low temperature is continued. The proper amount may be 
poured out and heated whenever it is required. 

" The other way is to make the mixture as just described, 
and stand it in warm water for fifteen minutes. This will give 
the proper amount of digestion. Then scald it ; this kills the 
ferment, and the milk can be kept with no more care than or- 
dinary milk. You can then take the proper amount and warm 
when it is needed, and you have no further trouble with it. 
For asylums, where there are many children, this is probably 
the best way. This gives us milk which is as exact an imita- 
tion of the natural milk of the mother as we can expect to 
obtain it in practice." 

The extract of pancreas can be obtained at any drug store, 



PREPARED BOTTLE. 151 

and peptonized milk is at present highly recommended by all 
physicians in this country and Europe, when prepared according 
to the directions just given, for infants who are suddenly de- 
prived of mother's milk or for those that are sick. A certain 
amount of care is required in the preparation of this food, 
because if the peptonizing process goes on too long the milk 
will become bitter and the child will refuse it ; if it does not 
go on long enough, the curd, of course, will not be affected. 
There is another quality which the extract of pancreas pos- 
sesses that is as important as that of the digestion of casein, 
which is, that a small quantity of it, when added to the broken 
starch-granule, will aid in converting it into grape-sugar and 
thereby render it digestible ; for instance, if a child's bottle be 
made up of barley-water and milk or oatmeal, a few drops of 
the extract of pancreas in solution will render certain its 
digestibility. And for children who have a tendency to diar- 
rhoea, or with whom starchy food fails to agree, this can be 
made use of. 

This brings us to another subject. Anything which will con- 
vert the cereals into grape-sugar before the food is taken to the 
child, will aid in nutrition. Why ? Because these cereals not 
only contain starch, which goes to supply fat and heat, but 
they also contain albuminoids, as gluten and other nitrogenous 
materials, which go to the formation of muscular tissue, and 
salts, which are bone-forming. If the whole grain can be so 
prepared as to be perfectly digested, a great deal will have been 
gained in the nutrition of the child, and for this object various 
foods have been suggested. A substance which converts starch 
into sugar is diastase, or malt. Each granule of the cereals 
possesses a certain ferment which, if allowed to develop by 
heat and moisture, will turn the starch into sugar. This is 
made use of in the preparation of food for children, such as 
Liebig's foods, where the starch has been turned into grape- 
sugar by malting. As will be readily appreciated, there is no 
necessity for the addition to the milk for very young babes, or 
for those that are very delicate. Mellin's food is prepared on 



152 MOTHER AND CHILD. 

the same principle. It is a fat-making and nourishing food, 
which when taken into the stomach will increase the nutrition 
of the body and store up a certain amount of fat. and is valuable 
because it requires very little digestion. The child at birth, 
however, requires simply milk of the character which nature 
presents. It needs no more albumen and no more sugar. 
What we want is to supply a milk as nearly as possible of the 
quality furnished by nature. All that we need is a milk which 
will be digested and readily absorbed. But we insist upon the 
importance of feeding a babe from birth to at least three 
months on some preparation of milk alone. 

Any preparation of malt that will aid the digestion of starchy 
food is useful, not only for adults who suffer from flatulence 
and debility of the digestive organs, but it is also good for 
infants, when given in moderation ; but we advise mothers to 
avoid these preparations for their very young babies. This leads 
us to the consideration of those foods, in addition to the child's 
bottle, which either aid in the digestibility or are themselves 
of value in supplying nourishment. According to Professor 
Leeds, these classes of foods may be divided into the milk foods, 
the farinaceous foods, and the Liebig foods. We give many 
of the different preparations under these headings, in order 
that the mother can intelligently make her choice, should one 
not agree with her child. 

We have said before, and may repeat it here, as it is a very 
important matter, that the choice of a food for a child is a 
matter of experiment, for what agrees with one may not agree 
with another, even in the same family ; that the test of whether 
or not a food agrees with a child is if the child thrives upon it,- — 
if it sleeps well, if its flesh becomes firm, if its digestion is good, 
if its temper is amiable, and if it gains in weight, — because a 
cross child, in nine cases out of ten, is either a dyspeptic or a 
sickly one. These tests are the only ones that are of value, not- 
withstanding the advertisement that such and such foods are 
the only ones that agree with the baby. As the child grows 
older, a farinaceous food may be given in the way described 



PREPARED BOTTLE. 153 

before. Should the passages become constipated and there be 
much flatulence, should the child suffer from colic, become rest- 
less at night, lose its appetite, then the change should be made 
to one of the Liebig foods, and in this way its digestion encour- 
aged and nutrition established. An intelligent mother watch- 
ing carefully her child can thus be guided in the choice of its 
food; but it should be always borne in mind that as milk con- 
tains all of the elements for nutrition in such proportion as is 
required, those foods which are not milk foods should always 
be made up with milk in the preparation of the bottle; and if 
fresh cow's milk cannot be obtained for this purpose, a milk 
food well diluted should be used, such as ordinary condensed 
milk, fresh evaporated milk, or one of the milk foods given in 
the table : 

MILK FOODS. 



Carnrick's Soluble Food, 

Anglo-Swiss, 

Grerber's, 

American Swiss, and others. 

FARINACEOUS FOODS. 

Blair's Wheat, 

Hubbell's Wheat, 

Imperial Granum, 

Hard's Food, 

Kidge's Food, 

Eobinson's Patent Barley, 

Bethlehem Oatmeal, and others. 

LIEBIG FOODS. 

Mellin's, 

Malted Milk, 

Lactated Food, 

Hawley's, 

Keasby & Mattison's, 

Savory & Moore, and others. 



154 MOTHER AND CHILD. 

Frequently a child may be so weak or exhausted from disease 
or from inanition that food of the mildest character will not 
remain on its stomach. It would be useless to keep on diluting 
condensed milk, as it would render it valueless. In cases of 
this sort, the white of an vgg shaken up in a bottle of warm 
water to which a couple of grains of lactopeptine or Fairchild's 
liquor pancreaticus is added, sweetened and given by the 
bottle if the child will nurse, and by spoon in small amounts if 
the child will not, is very nourishing. Wine-whey can be given 
in the same manner. Gum-arabic water will nourish for a sur- 
prisingly long time, and allay irritability of the stomach and 
bowels, and finally, the child can be gradually encouraged to 
take small and repeated quantities of peptonized milk. No 
babe, of whatever age, should be fed exclusively for any length 
of time on bottle-food that has not fresh milk as one of its 
ingredients. We insist upon this, as cases of scurvy have un- 
doubtedly come from the prolonged use of stale preparations. 

It should be remembered that all infants need water. For 
the nursing babe a tablespoonful of boiled water should occa- 
sionally be given ; for the bottle-fed babe an occasional bottle of 
.vatcr is a necessity and must not be forgotten. 



CHAPTEE XXXIV. 

WEANING. 

The question is often asked, At what age should weaning 
begin, provided that there is no immediate necessity, and how 
should the process be managed ? It greatly depends on the 
family arrangements for spending that season of the year 
which in this part of the world is most to be dreaded, the 
summer. Of course, if a child is to be taken to the sea-shore, 
or some cool summer resort, where milk can be supplied fresh 
and in abundance, the question of weaning in the summer-time 



WEANING. 155 

has not half the importance attached to it that it has to those 
who are obliged to spend the summer in, or near, one of our 
large cities. Our own opinion is that if a child has been nursed 
for four months, certainly for six months, the gradual addition 
of a bottle to its dietary will be of advantage. A child 
partly nursed and partly bottle-fed, after its fourth month, 
thrives better than one bottle-fed alone ; in fact, breast-milk 
helps to make the bottle-food more digestible. Not only is 
this the case, but it is a great relief to the mother, gives her 
more time to rest, occasions less drain upon her nutrition, and 
is also of importance should the child be obliged to take the 
bottle, either because the mother's milk gives out, she becomes 
pregnant, or her health gives way; but four months is young 
enough, provided the mother's milk is found to be of good 
quality, nourishing, and the child thrive upon it. An occa- 
sional bottle, in addition to nursing, will have a tendency to 
concentrate the breast-milk, making it more nourishing, and 
thus avoid the necessity of weaning altogether for a few 
months more. 

The addition of a bottle or two during the night will give 
the mother a good night's rest, — a most important matter. 
Apart from the great importance to the child, the nursing by 
its mother will have usually a most desirable effect upon her 
own health, unless she be consumptive. It is a law of nature 
and therefore is beneficial. It will aid much in reducing the 
womb to its normal size ; indeed, a mother who does not nurse 
her babe is apt to have some womb trouble following her labor. 

For a child that is born as late as January or February we 
would not recommend the addition of any bottle-food until 
the following October, provided the mother is able to nurse it. 
For a child born in October or November, and especially when 
the following summer can be spent out of town or at the sea- 
shore, the w^eaning process could possibly be all over by May. 
If a mother is strong and hearty, has no consumption in the 
family, has plenty of milk, is not in the least pulled down by 
nourishing her baby, and can nurse it a year, it is so much 



156 MOTHER AND CHILD. 

the better. For the last six months her child can take some 
bottle-food in addition. A mother should not nurse her child 
for more than a year ; there is no necessity for it. The milk is 
not sufficiently nourishing, and unless it is supplemented 
by the bottle the chances are that the child will become 
sickly. Indeed, a good, strong, healthy child that becomes 
accustomed to the bottle-food will wean itself before that 
time is up, and this is exactly what we wish a child to do, — 
to wean itself. Now, in the gradual process of weaning or 
the addition of a bottle to its regular nursing, the babe of 
five or six months may take its food according to the following 
programme : It should nurse from its mother in the morning at 
six or seven, and then after its bath take a bottle about half- 
past ten or eleven o'clock ; possibly nurse from its mother 
about one or two o'clock; again a bottle at five or six; and 
then the mother should nurse it on retiring at ten or eleven. 
In this way it becomes gradually accustomed to the bottle at 
the time of day when it is most apt to agree. This also gives 
the mother an opportunity to take exercise and rest. Possibly 
it may need a bottle about four o'clock in the morning. 

The question is asked, What should be the first choice when* 
selecting the bottle-food of a child at this age, — four months? 

Certainly the first choice should be the simplest preparation 
and one which will tax the digestive organs least. The chapter 
on bottle-feeding should be consulted in regard to this matter, and 
that preparation of milk, cream, milk-sugar, and lime-water rec- 
ommended by Dr. Eotch or the proportions advised by Professor 
Leeds should be tried first, remembering that the mixture must 
be sterilized, and that the sterilization at 155° F. is the one we 
particularly advise. The next bottle-food that can be tried is 
the formula of Dr. J. F. Meigs, of milk, cream, gelatin, arrow- 
root, and lime-water, and finally, barley, oatmeal, rice, or flour 
can be added as is advised in the chapter under consideration. 
As the child grows older, the mid-day bottle can be varied. We 
believe that by using a mixture of the cereals we often get a 
more palatable and more nutritious preparation than by using 



WEANING. 157 

them singly ; thus, oatmeal and barley, or Graham flour, can 
be used together, or oatmeal and rice. The child will show a 
decided preference for some kind of bottle-food, but bear in 
mind that it is a great mistake to stuff a child. The mother will 
often be tempted "to add a little more oatmeal, or Mellin's food, 
etc., thinking that a little increase will make her baby stronger 
and rosier. This may be true if the child lives in the country 
or at the sea-shore, where it is out of doors all day long, in a 
cool, bracing climate, especially if it is able to run about ; but 
if mothers could see, as doctors do, the numbers of sluggish, 
heavy children that our cities afford, with coated tongues and 
foul breaths, and constipation, who are fairly packed with 
" baby foods" and all the most concentrated articles of diet 
that modern chemistry presents us with, they would under- 
stand why it is that the ill-fed, ill-clothed children of the poor, 
who live on a crust and digest it, are so much more able to 
resist disease than their own. It is on this account we believe 
that, although outmeal is a most valuable addition to the diet, 
it should only be used in small amounts, should be thoroughly 
boiled, the children when taking it kept out of doors as much 
as possible, and should not be used in hot weather, nor with 
children who have what is called a " bilious tendency." 

If fresh cow's milk is not obtainable, condensed milk can 
be used in this gradual weaning of children : one part to ten 
parts of water, and fresh cream as before recommended. Some 
studies we made a few years ago convinced us that woman's 
milk contains a diastase or ferment capable to a slight degree 
of turning starch into grape-sugar, and that cow's milk does not 
possess this. Possibly this accounts for the excellent results 
that are frequently found in the association of breast- and 
bottle-feeding. Let us here say again that when we use any 
substance besides milk in its bottle, such as the cereals, we 
should not forget that the child needs water, — pure, clean water 
to drink. Yery often a child that is partly bottle-fed and 
partly nursed is restless at night, — will not sleep. Instead of 
the mother's trying to put it to sleep by nursing it, if she 

14 



158 MOTHER AND CHILD. 

would simply give it some water in its bottle, or possibly a little 
Mellin's food in the water, it would go to sleep and not run the 
risk of indigestion from over-feeding. 

Dr. A. Jacobi, 1 writing of the necessity at times for supple- 
mental feeding, says, — 

"Such practitioners and authors who convinced themselves 
of the ill success often attending the use of milk, or watered 
milk, commenced at an early period to mix it with meat-soups, 
meat-tea, or egg. The administration of some beef-soup, well 
made, a cupful every day (mutton-broth when there is a ten- 
dency to diarrhoea), is advisable towards the end of the first 
year. Long before this period, indeed, at any time during 
infancy, is it indicated in cases of early rhachitis, rhachitical 
constipation, undue adiposity, and retarded teething. 

"Beef-tea, well made, in the bottle swimming in the water- 
bath, is still believed by some to be the model food. That it is 
not so rich in soluble albuminoids as was believed, ought to be 
generally understood by this time. What, however, it does 
contain in large quantities is salts. Thus, it is a dangerous 
article in summer diarrhoea, and must never be administered 
by itself. "When given at all, it ought to be in combination 
with farinacea, raw albumin (which, in this mixture, requires 
very little salt, if any). 

" Egg has been utilized as an admixture to milk, or as its 
substitute in a great many ways. The yolk and the albumin 
have been so employed. The white of an egg, with a little 
salt and six ounces of water, well beaten and shaken, is a 
good mixture, which can take the place of infant food but 
temporarily, but is an invaluable makeshift in severe intestinal 
catarrh, or a permanent nutriment in the same when added to 
other food. 

" In the course of the second half-year some changes may be 
made in infants' diet. In the relation of the barley prepara- 
tion to the milk a change should be made ; the milk may exceed 
— • 

1 Intestinal Diseases of Infancy and Childhood, p. 89. 



WEANING. 159 

its former quantity, and in the same proportion in which the 
children are permitted and accustomed to drink pure water, 
the food may become more condensed. Towards the end of 
the first year the quantity of barley or oatmeal to be used in 
the decoction may be increased. It is soon enough to begin 
the use of pure milk in the third half-year, if at all. About 
the eighth or the tenth month the chewing of a crust of bread 
or of a piece of " zwieback" may be allowed. About this time, 
too, the daily allowance of meat-soup may be increased to two 
hundred and fifty grammes, and in addition one or two tea- 
spoonfuls of broiled beef may be given. These articles, dis- 
tributed through four or perhaps five meals, will be sufficient 
for the greater part of the second year. The quantity may 
be gradually increased, but a more radical change is useless. 
If a child, which is healthy and is not spoiled, awakens at 
night, it needs and desires nothing but a drink of water, or of 
thin barley-water without milk. . 

" About the middle of the second year, when the child begins 
to use a spoon, the breakfast may be made up of more solid 
elements than heretofore, barley broth or oatmeal mush, thor- 
oughly cooked, an egg, a glass of milk, a piece of stale bread 
with or without butter. The child must be taught never to 
drink milk in haste. It will be digested better when time is 
taken. The daily quantity of meat, preferably beef, to which 
gradually may be added lamb or chicken, may now be increased 
to one hundred grammes, and this is to be at two or three 
meals. The evening meal must be similar to that of the morn- 
ing, and lighter than the mid-day meal. Neither at this age, 
nor later, should nervines, stimulants, condiments, coarse vege- 
tables or salads, coffee, tea, wine, beer, play any part in chil- 
dren's diet. A piece of sugar, after a meal which is frugal but 
rich in albuminoids, will prove an agreeable and useful addition. 
Children from two to three years of age will get along well 
on four meals daily. Those who are a little older may do with 
three, provided they get once a day between meals a piece of 
bread and a drink of milk, made agreeable and more digestible 



160 MOTHER AND CHILD. 

by the addition of a little salt. Before children are two years 
of age no vegetables in any quantity should be given to them. 
Small quantities may be given later on ; they will be accept- 
able and be readily digested. As age advances, the diet should 
approximate, more and more, that of grown people. Alto- 
gether, there is no easier and no more grateful task than that 
which consists in accustoming children to a simple diet, and to 
shape their habits and their demands into harmony with those 
of nature from the first year of life." 

Bear in mind, that if in the summer-time, a child takes more 
food than it can digest, this food is apt to decompose, act as an 
irritant, and possibly give rise to an inflammation that will end 
in summer complaint. Suppose, then, that a child has been 
weaned from the breast, and the object now is to gradually 
take it off the bottle or give it some additional food besides 
that which it takes in its bottle. We may presume that its 
bottle has been agreeing with it, but that for the last few weeks 
it has turned against it, as it were: it seems to crave more 
solid food. Certainly by the time it is twelve months old it 
could very well be given a small cupful of chicken-broth or 
beef-soup. Possibly before this time it has been given, instead 
of the usual bottle after waking from its mid-day nap, some 
boiled bread and milk ; and now, instead of bread and milk, 
some chicken-broth, with a little dry toast soaked in it, can 
take the place of this meal, and the bread and milk be given 
for supper about six o'clock. In this way the " bill of fare" 
for three meals can be gradually mapped out, and the child 
permitted to masticate part of its food ; this will aid the cut- 
ting of the teeth as well as increase its digestion. When a 
child takes bread and milk in this way it is always well to let it 
have an occasional drink of plain milk, and we must never 
forget that it also needs from time to time some fresh water. We 
repeat this constantly, as we want to impress upon mothers that 
much of the complaint about the constipation of bottle-fed 
babes comes from the want of drinking-water. 

Yery often during the course of weaning it is advisable to 



WEANING. 



161 



give a child soups or, preferably, broths and beef-juice. The 

latter is frequently given in preference to soups, as it is readily 

, digested and is most 

nutritious and blood- 

' making. 

To make good beef- 
juice a piece of lean 
beef from the round, 
preferably of fresh meat 
and not that which has 
been frozen, should be 
used. Chop this fine 
and remove every shred 
of fat, heat slightly, and 
use a meat-press. A 
tablespoonful of juice 
thus expressed is enough 
for any infant at a time. 

Of the read}' -made ex- 
tracts we have found 
Yalentine's most reliable 
and also Eudisch's sareo- 
pep tones. 

Dr. Jacobi, writing of delicate children who suffer from dys- 
pepsia caused by intestinal catarrh, says, — 

" Most cases, in older children, bear boiled milk, strained oat- 
meal, barley gruel, stale wheat bread, and a few also raw beef. 
Some take nothing but boiled milk, or buttermilk, or koumiss. 
Many, particularly convalescents or adults, will tell you that 
they do not digest milk. That may be true, but then they 
gulped it down and it formed a large caseous cake in the 
stomach that was not afterwards dissolved and digested. They 
must boil their milk in the morning and heat it several times 
during the day almost to the boiling-point. They must add a 
small quantity of table salt to it ; also, in case the stomach is 




Meat -juice press. 



very acid, some bicarbonate of sodium, 
I 14* 



or 



calcium, or magne- 



162 MOTHER AKD CHILD. 

sium. They must not drink their milk, but pour it upon a 
plate and sip it with a spoon. Thus prepared, they will digest 
it, particularly when it is not quite cold. In fact, many require 
their meals warm or hot. 

" For the purpose of easier digestion, milk may be peptonized 
according to Fairchild's directions, or it may be rendered more 
digestible by the process recommended by Dr. Eudisch. This 
consists in mixing one part of dilute muriatic acid with two 
hundred and fifty parts of water and five hundred parts of 
raw milk, and then boiling it. 



CHAPTEE XXXY. 

MENSTRUATION. 

We will devote a few moments to the consideration of the 
changes which take place in girls at puberty, partly from the 
fact that at this time we are still within the period of the 
second or permanent dentition. Indeed, it will be noticed 
that at the very age when menstruation first shows itself, the 
girl is susceptible to all those functional disturbances that may 
be brought about by the cutting of the four second molars, a set 
of teeth that are developed anew, not replacing any of the 
milk-teeth. Sufficient attention has not been called to the dis- 
turbances caused by the pressure of the twelfth-year molars. 
These may show themselves in either dental neuralgia or, in 
fact, any form of trifacial neuralgia, gastric disorders, or men- 
tal peculiarities amounting to melancholia, or symptoms of 
acute meningeal irritation. No wonder, then, that it is most 
important that the young girl should be under the care of a 
mother properly instructed to guide her and guard her during 
this time. The natural impulse of her sex is towards sedentary 
occupation, seclusion, long dresses, and possibly her first real 
novel, — all of these in themselves pernicious : they weaken 



MENSTRUATION. 163 

her muscles, lessen her appetite, tend to constipation, and ex- 
cite her brain. 

It is scarcely necessary to mention the boys at this age. 
The out-door life that tbey lead, especially at the present time, 
when there is so much for a boy to do, tends to keep them in 
good physical condition, and renders them insusceptible to the 
many reflex disturbances which might otherwise exist. We 
quote from a paper upon this subject as follows : x 

We all recognize the very great importance of all that tends 
towards muscular development in growing girls. They should 
be symmetrically developed, should have full chests, straight 
backs, and strong limbs. We should also urge the importance 
of clothing of light weight and loose fitting, the principal 
strain being on the shoulders, not on the waist and hips, and 
also the evil results of cramped, stooped positions in the school- 
room, eye-strain, and bad ventilation. We all urge these mat- 
ters daily, and we know how little attention is paid to them. 
But there are certain forms of various disorders which occur 
about the time of the second dentition that deserve more 
than a passing notice. These are manifested either as chorea, 
(St. Yitus's dance), nervous excitement, such as night ter- 
rors, and various mental disturbances (misnamed hysteria), 
gastro-intestinal disorders, and evidences of malnutrition. 
The child will probably become languid, suffer with frontal 
headache, become peculiar in her disposition and show fits of 
temper, shun society of other children, lose her appetite, be- 
come despondent, and possibly develop a local twitching of 
some of the facial muscles. It is customary to say that this is 
all reflex, is possibly a warning that the system is undergoing 
some change preparatory to the menstrual functions, — that it 
is, in fact, a true hysteria. This may or may not be the 
case. Our own impression is that it is often due to the anae- 
mia (impoverished blood) brought about by rapid growth and 

1 Published in the Medical and Surgical Keporter by Dr. J. M. Keating 
October 23, 1886. 



164 MOTHER AND CHILD. 

development, with faulty assimilation and deficient oxygena- 
tion. 

The nervous system seems to run riot, but this very excite- 
ment in itself is an evidence of the demand on the part of 
nature for a blood-supply which is nutritious and well oxygen- 
ated. All the exercise in the world, all the most nutritious 
and sustaining of foods, will have no effect until the digestive 
organs are made to perform their normal functions. If you 
examine the tongue you will find it coated; the breath is 
foul, the bowels are sluggish, the appetite is perverted, the 
child craves extraordinary articles of food, especially acids and 
sweets. She has a disgust for her regular meals. There is 
flatulence, cardiac palpitation, often asthma after exertion. 
The urine is either scanty and high-colored or very copious 
and light. If the menses have been established, they are scanty, 
colorless, and irregular, or there is a leucorrhcea. In these 
cases the recommendations of popular writers for gymnastics, 
friction, milk diet, etc., are admirable after the digestive organs 
have been cleared of their accumulation and the normal func- 
tions whipped into activity. 

As far as the general treatment is concerned, the patient 
should be sponged every morning with tepid water; she 
should stand in a tub, and have a pitcher of it poured down 
her spine from the nape of her neck, and then be thoroughly 
rubbed into a glow with a soft Turkish towel. The breakfast 
should consist of warm milk or cocoa, a soft-boiled egg, a rare 
steak or chop, either oatmeal, cracked wheat, grits, or Indian 
meal alternating; bread and butter, not hot cakes. For dinner, 
soup, rare meat, fresh vegetables, ripe or stewed fruits. For 
supper, stewed fruits, bread and butter, warm milk or cocoa, 
neither tea nor coffee. She should retire early, and not be 
permitted to read at night. The supply of oxygen should 
come from out-door exercise, not an over-indulgence in walks or 
games that fatigue ; let the school-hours be limited to the early 
part of the day, and avoid that abomination of preparing long 
lessons in the afternoon or evening for next day's recitations. 



MENSTR UA TION. 165 

Moderate calisthenics, or massage, should be daily given. 
In about a week's time the girl will be able to bear iron alone, 
and the tincture of the chloride can be given in ten- or fifteen- 
drop doses for some time, or a chalybeate water can be given 
with arsenic. The digestive organs will now also tolerate 
milk in large quantities, provided it is of medium richness, is 
fresh, and given warm. 

But this is not all. There are very many cases of a highly- 
nervous type which, despite the most careful treatment, will 
not improve at home. The constant association with parents 
of like temperament, however solicitous they may be in 
carrying out instructions, is of itself a cause of nervous irri- 
tation. It may be necessary to send such children from home, 
either to some relative, living possibly in the country or some 
distant city, or perhaps to some suburban or country boarding- 
school, where a thorough change of air and scene and the 
association with girls of a different temperament will work 
wonders. 

The age at which menstruation appears cannot, of course, 
be definitely stated, so much depends upon climate, race, social 
position, and family peculiarities. Ordinarily, about the age 
of fourteen may be taken as the average in the temperate 
climate. Of course, whatever tends to early development, 
such as warm climate, in-door occupation, and especially 
among those whose occupation is sedentary or where it is 
attended with much mental excitement pertaining to literary 
pursuits or the excitement from the whirl of society life at 
too early an age. may bring about an early appearance ; whereas 
the contrary may have a retarding effect. 

The period at which this change to pubert}" takes place is 
marked by a series of phenomena which show the revolution 
undergone by the system. For some time previous the nervous 
system has felt the change ; the temper becomes variable, at 
times uncertain. A girl who before was probably gay and 
boisterous in her deportment becomes timid and shy, easily em- 
barrassed, the slightest cause making her blush, the knowledge 



166 MOTHER AND CHILD. 

of which may add to her embarrassment. She may notice a 
gradually increasing development of her figure, which annoys 
her and makes her shun company. Her younger companions 
no longer have the same charm; involuntarily she prefers the 
society and dress of those older than herself. The watchful 
mother at once recognizes the cause which is bringing about 
these changes, and it is her duty to gain the confidence of her 
child and, without exciting her suspicions or disturbing her 
already uncertain nervous system, lead her to understand that 
she is no longer a child. In this way should the matter be ex- 
plained to her by her mother. She is a woman, and it falls to 
the lot of all women who are in good health to have a certain 
monthly drain upon their system which is calculated to relieve 
the other organs of the body ; and should it appear at any 
time, which it is now likely to do, she should avoid all things 
that might check it, and take certain precautions, as rest, etc., 
to secure its regular return, which should be painless. As this 
often in many cases comes unawares, certain precautions in 
clothing have to be taken ; especially is this the case if the 
child should happen to be away from home at this time. Then, 
again, it is well for her to learn that the menstrual flow may at 
times, especially in delicate girls, be attended by severe pain, 
by nervous prostration, in fact, by a constitutional thunder- 
storm. There may be severe headache (frequent in such cases), 
colic, — this latter may be extremely severe ; there may be 
giddiness, nausea, extreme nervousness, chills or creeps, exces- 
sive backache, all of which may come on suddenly, following 
some slight indiscretion in diet which tends to mislead the 
person as to its true cause. 

"When a young girl once distinctly understands that the 
object of her monthly flow is to keep her in good health, — and 
this surely is the light in which it should be presented to her, — 
she will readily understand that to secure the health which is 
heaven's greatest blessing she must be strictly guarded as to 
the care of herself. She should understand that after one ap- 
pearance the periodicity of this function is not at once estab- 



MENSTRUATION. 167 

iished ; there is frequently great irregularity in its return. It 
may last but a few hours and then return in fifteen days; it- 
may be copious at first and then not return for two months or 
more. Instead of appearing, as it should, at the time of its ex- 
pectation, it may appear as a bleeding from the nose, or it may 
be replaced by a diarrhoea or by a leucorrhcea. 

There are certain signs which note the advance of a period, 
and it is well for the mother to impress upon her daughter to 
watch them carefullv. Although the normal return of the 
period is calculated by the lunar month, really the idea that the 
moon exerts an influence upon this condition has no basis; this 
is shown by the fact that the day of return differs in women. 
Again, some have the normal return every thirty, others every 
twenty-five or twenty-eight days. The duration of the period 
also differs in most women ; in some it lasts three or four days, 
in others eight or more. The quantity also differs ; the range 
comprised within the area of health is widely spread. These 
facts are important to bear in mind ; though should any devia- 
tion exist from that which the mother believes to be the normal 
condition, she should mention the fact to the family physician, 
and let him be the judge of its importance. 

During this period of life there is a tendency in certain 
types of young girls to develop what is known as hysterical 
phenomena. !N"ow, it is well to know that what is understood 
as hysteria by physicians is not merely those attacks which 
people call hysterics. 

Physicians frequently hear this reply, "But, doctor, my 
daughter is not hysterical; she is of the most amiable disposi- 
tion . I know her to be extremely brave and fearless." At the 
same time she may be a marked subject of hysterical vomiting, 
or some of the paralyses. It is a difficult matter to decide 
whether these troubles — which are usually termed reflex by 
doctors, because they are sympathetic or reflected from other 
organs through the chain they have in common, the delicate 
nervous system — are due to disturbance in the generative sys- 
tem or are simply the result of an associated weakness, of 



168 MOTHER AND CHILD. 

which the disturbed menstruation, the pain, or the diminished 
quantity of the flow is another evidence. 

In many cases the "womb-troubles," which may simply be 
irregularity of the function of menstruation, may be the cause, 
and rest, hot foot-baths, laxatives, etc., bring about a cure ; or it 
may be due to weakness on the part of the individual, poor 
blood, deficient out-door employment, too much standing, as is 
so common with store-girls, and only yield to tonics, fresh air, 
ample diet, and exercise. 

What is generally understood as hysteria by the non pro- 
fessional is an outburst from the nervous system upon the 
slightest irritation, whether pleasurable or painful. To a certain 
extent this is independent of any disease or even disorder of 
the generative system, and is solely, we regret to have to say, 
due to bad " bringing up." Gentle, over-indulgent, tactless 
parents are themselves the cause of such a state of affairs. 

It is not for us to study the cause of these changes in indi- 
viduals that produce this function, nor to describe the anatomy 
and physiology of the organs that are engaged in it. It is 
merely necessary to insist upon the fact that normal menstrua- 
tion should be painless, and that disturbances occurring at this 
time, whether in the form of local pain, headache, or lassitude, 
bear the same relation to normal menstruation that discomfort, 
nausea, and pain bear to healthy digestion. Just as dyspepsia 
is dependent upon indiscretion in diet, or weakened digestion 
from debility, so difficult or painful menstruation is the result 
of indiscretion at the time when care and watchfulness should 
be the rule, or it is the penalty paid for neglect at some earlier 
period. 

Debility in early girlhood is one of the principal causes of 
pain when the function is established. It is usually found in 
rapidly-growing girls whoso tastes have led them enthusias- 
tically into literary pursuits, partly from a feeling on their part 
that their muscular weakness will prevent their taking pleasure 
in the rough out-door pleasures of their more robust companions, 
and partly from the extreme excitability of their nervous 



MENSTR UA TION. 169 

system, which makes them at an early age noted for their 
brilliancy, and which will also exaggerate their liability to pain. 
Such children are easily recognized, and to them the watchful 
mother should give her careful attention in anticipation of 
what their development will bring forth. Their studies should 
be gently directed towards those pursuits that lead them out 
of doors ; the muscular exercise involved in household duty 
should be gradually given them ; habits of early rising and 
early to bed should be insisted upon. There should be a 
judicious division of their school-hours, the selection of well- 
ventilated and bright school-rooms, daily gymnastic exercise, 
swimming, riding, and walks, — not the aimless promenading 
the streets, but walks that are calculated to give both pleasure 
and profit. There is no better way of making healthy girls 
than to make the various branches of science, according to 
their taste, a part of their education ; there is not a girl, or 
in fact any individual, who has not a latent taste which, 
with a little care, can be developed. If fond of drawing 
or painting, encourage it from the earliest moment: teach 
her to draw from nature, and she will spend hours in the 
open air. Botany, mineralogy, photography, will embrace the 
repertoire of an educated woman as well as Latin and Greek, 
and a woman's mind is capable of accommodating them all, if 
necessary. 

Unfortunately, the present fashion is totally at variance, 
strange to say, with that of the ancient days of Greece and 
Rome. Nowadays it seems that a person can learn nothing 
except in an ill ventilated school-room, in a barrel-hoop posi- 
tion. The philosophers of ancient days studied as hard as 
those of modern times, but they sought the solitude of the 
woods, and made their studies a pleasure instead of a task. 
It is not intense study that breaks so many down ; it is the 
confined air, the sitting in a bent posture, the loss of appetite, 
the muscular weakness, and the poor blood that does the 
harm. We wish we could impress firmly upon mothers the 
importance of an erect carriage in young, growing girls. It is 
h 15 



170 MOTHER AND CHILD. 

not merely the case tbat stooping shoulders and curved spines 
make their daughters unattractive in appearance, hut such 
conditions are absolutely a predisposing cause of disease; 
and we are satisfied from personal observation that such girls 
are fit subjects for tuberculosis and are always more or 
less affected with painful periods. To correct this before the 
age of puberty should be the aim of every mother. Make 
your girls straight from habit with shoulders well thrown back, 
and they will avoid many womb-troubles in the future. If 
out-door exercise does not seem to correct this habit, there are 
certain movements of the muscles, — light gymnastics, — which 
your family physician can tell you of, that are beneficial. One 
of the straightest and best-formed girls we ever saw — a picture 
of health — owed it all to her mother, who, noticing a gradual 
habit of stooping, required her to lie flat on her back on the 
floor without a pillow for one hour each day, while she read 
some entertaining book to her. Another matter, which is im- 
portant in this connection, is the question of young girls wearing 
corsets. Fortunately, so much attention has been paid lately 
to the subject of dress in England that those whose opinion is 
most valuable have freely expressed themselves. We fully en- 
dorse the view of the London Lancet in an editorial, that cor- 
sets should not be worn by young women ; their dress should 
always be made so as to give free and independent movement 
to every part of the body; their garments should be light in 
weight, and the burden should fall as much as possible on the 
shoulders ; there should be no restriction of any part of the 
body, and if a girl's figure needs a corset to make it shapely, 
let her endeavor to accomplish the same end by the more 
natural means of muscular development, which will at the 
same time give health as well as beauty. A strong back is far 
better than a corset. 

Young girls should know that when the time comes for 
their period they should avoid everything that would either 
postpone it or make it painful. If a horseback excursion has 
been fixed for that time, some excuse must be made ; if a boat- 



MENSTRUATION. 171 

ing-party involve exposure to the chilling air, by all means avoid 
it. Swimming, climbing, tennis, should be interdicted at such 
times. In avoiding extremes, one does not merely mean the 
extreme of doing too much, but also that of doing too little. 
The lounging about one's bedroom, or spending the whole day 
sitting reading a novel, will be as apt to give trouble as the 
opposite extreme ; it will make the circulation sluggish, tend 
to headache, make the liver torpid, give rise to indigestion, 
and weaken the system. If one is accustomed to moderate 
exercise, the daily avocations of life should not be interfered 
with ; but heavy lifting, or over-fatigue in walking, or too long 
standing, riding, dancing, or tennis, should be carefully avoided. 

We cannot lay too much stress on the importance of a careful 
regulation of the bowels, especially in its bearing upon the dis 
orders of women. Every one knows the necessity of estab 
lishing a daily habit, from the fact that the wastes of the 
body which are discharged through the intestine, if allowed 
to remain, decompose, are reabsorbed, and produce a certain 
poisoned condition of the system, made evident by furred 
tongue, nausea, distaste for food, disagreeable taste in the mouth, 
headaches, bad complexion, pimples and other disorders of the 
skin, rendering the individual miserable to herself and others. 
Constipation also allows an accumulation to take place in the 
bowel, which by distending it will press upon the organs that 
lie in contact, and cause the extreme pain so common at times, 
especially in the left side. Xothing should interfere with this 
daily duty ; but no one should use powerful purgatives icithout 
consulting a physician. 

Of course, fresh, pure water is the best laxative we know 
of, and a proper amount should be taken each day, usually 
at meals. Then fruits, ripe, raw, or cooked, should not be for- 
gotten, also fresh vegetables. The compound liquorice powder — 
a teaspoonful or more at night in milk or water — is a mild and 
excellent laxative. Occasionally upon rising in the morning a 
wineglassful of Eubinat-Condal water, Friedrich shall, Tarrant's 
aperient (teaspoonful), are excellent. The elixir cascara sagrada, 



172 MOTHER AND CHILD. 

compound rhubarb pills, and Lady Webster pills are efficacious, 
but the latter should not be taken for any length of time nor im- 
mediately before menstruation. Whatever medicinal laxative 
is used, it should not be made a matter of daily routine ; once 
or twice a week is sufficient, and alternating with an enema. 
Gluten (Health Food Co.) suppositories or glycerin supposi- 
tories are often useful. But whatever means is used, the child 
should be impressed with the importance of regularity as to the 
hour, and should never vary, never let anything else call her 
away; and parents should see that she has a comfortable closet 
to go to. Many a case of obstinate constipation has come from 
the dread of a cold out-house in an exposed yard. 

The varieties of disordered menstruation are known as 
amenorrhea, dysmenorrhea, and menorrhagia ; the former mean- 
ing absence of menstruation, the second difficult or painful 
menstruation, and the third an unusual flow at that time. 
Delayed menstruation — that is, where a young girl has reached, 
say, the age of nineteen without the appearance of the flow — 
is apt to give rise to much anxiety. If this is associated with 
evidences of tardy sexual development, it is not of itself 
alarming, and cases are on record where women have married 
and given birth to children without ever having menstruated. 
But it is always well, and especially if occasional signs are 
present of an attempt at the establishment of menstrual flow, 
not to allow this state of affairs to run on long. The family 
physician should be consulted, as the obstacle may be a me- 
chanical one, or certain causes may exist which could be readily 
removed, but which otherwise might lead to serious disease. 
It is a recognized fact that the general mortality of women is 
increased at this period of life, and as soon as the establish- 
ment of the menstrual flow takes place the mortality shows a 
reduction. In the cases just mentioned it will be readily un- 
derstood that to attempt to bring on the period by hot baths, 
or especially by the severe and forcible means of powerful drugs 
obtained without the doctor's consent, would be harmful, even 
fatal, and we regret to say that many such accidents happen. 



MENSTRUATION. 173 

Dr. Mathews Duncan thus writes of delayed menstruation : 
" Like other processes of development, that of the generative 
system admits of considerable variation in point of time, with- 
out of necessity passing the limits of health. Indeed, just as 
one child cuts its first tooth at seven months and another not 
till a year old, so one girl will menstruate at fourteen to fifteen, 
and another not till seventeen." Weakness or feebleness of 
constitution, more or less the result of city life, may be in 
itself another cause for this condition. We quote again from 
the above author : 

" A girl previously in good health approaches the time of 
puberty; some of the changes characteristic of it take place: 
the form assumes the contour of womanhood, and nothing but 
the occurrence of menstruation is wanting to announce the 
completion of the change. The menses, however, do not show 
themselves, but the girl begins to suffer from frequent head- 
aches ; and the flushed face, frequent backache, pains in the 
lower portion of the abdomen, constipation, a furred tongue, 
and a full pulse, and all these signs of constitutional disorder 
undergo a marked increase at stated periods of about a month. 
At length menstruation occurs, though in all probability 
scantily, and attended with much pain, and then for several 
months together there is no sign of its return. The general 
health was at first probably not seriously disturbed, but by 
degrees the patient becomes habitually ailing, the appetite 
falls off, the powers of digestion are weakened, the strength 
becomes unequal to ordinary exertion, the pulse grows feeble 
and frequent, and the face itself assumes a pallid, sallow tinge, 
whence the term ' chlorosis,' ' green sickness,' has been selected ;" 
and it might be added that such patients are not by any means 
necessarily thinner than usual. The great mistake most 
people make is to attribute this to disorder of the liver ; they 
call it biliousness, and are apt to do harm by overdosing for 
this supposed condition. Again, they will imagine languor 
represents weakness, and immediately have recourse to some 
strong preparation of iron or the inevitable dose of quinine, 

15* 



174 MOTHER AND CHILD. 

and then seem surprised that no improvement follows. It is 
the tonic influence of fresh air, healthful pursuits, exercise 
short of fatigue, and a nourishing, wholesome diet, of which 
milk should form the essential feature, that does most good, 
aided by those drugs which the investigation of the careful 
physician has warranted his suggesting to aid nature. 

In the treatment of this form of difficult menstruation, 
which is applicable as well to those cases where, from one 
cause or another, the period has been missed by an ordinarily 
healthy girl, either from exposure to cold or the result of some 
shock to the system, or perhaps from the debility consequent 
upon convalescence from fever, or some such cause, Dr. Dun- 
can saj-s, " The patient should be kept quiet, and if there is 
any considerable suffering or much disturbance of the circula- 
tion, it is desirable that she remain in bed, while the hot hip- 
bath night and morning should be rendered still more -stimu- 
lating, in cases where the local pain is not considerable, by the 
addition of some mustard." A gentle laxative should be admin- 
istered, such as a dessertspoonful of the compound liquorice 
powder, or a teaspoonful of magnesia or phosphate of soda, or, 
better than all, probably, a dose of castor oil. Should there be 
much pain, hot applications to the abdomen, either in the form 
of a light meal poultice or a flannel bag of hops wrung out fre- 
quently in hot water, in addition to a hot foot-bath. Under 
no circumstances whatever should the powerful irritants sold 
in the drug-shops for such purposes be used ; all drugs should be 
left for the physician to order. The use of hot teas is recom- 
mended, — ginger tea, tansy tea, etc., — and by such means en- 
deavor to encourage and not force the habit of menstruation. 
An excellent tea can be made from powdered ginger, senna, 
and dulcamara ; it is laxative, and can be used every night 
with no bad effects. 

The subject of pain during this time next claims our atten- 
tion. At times it is so intense as to demand immediate relief; 
and frequently persons, especially those who have not the 
mother's care or her experience to guide them, will put off 



MENSTRUATION. 175 

» 
month after month the consultation with their physician, 
hoping that time will bring relief, and endeavor by various 
means to struggle through the periods which to them bring re- 
newed horrors, and which finally wear them out by the constant 
effort to withstand the pain. And what means do they adopt 
to obtain relief? We regret to say it, little reflection is given 
as to the cause of the disturbance. The period once over, they 
assume the same habits which have resulted in making a func- 
tion normally painless fraught with pain ; the same giddy life 
of society or the same over-indulgence in mental excitement 
and all that tends to enervate both body and mind. The cause 
of their trouble never for a moment attracts their serious atten- 
tion ; the treatment that they apply for their relief consists 
only in that which dulls their sensibility and deadens their 
nervous system. Alcohol in some form, whether gin or brandy, 
and opium, bromides, or chloral are used in large amounts, 
and made to play the part of the greatest curse of a house- 
hold. 

We do not mean to say that all those who suffer do so on 
account of indiscretion, nor do we believe that the most rigorous 
and careful living would at once relieve the tendencies to peri- 
odical pain ; but we cannot dwell forcibly enough upon the fact 
that those whose temperament is such that the slightest cause 
will result in hours of torture, can be in time relieved by rest, 
nutritious diet, and careful living. 

If there be one cause more frequent than others to which 
the agony of the period is due, it is constipation. When the 
question is asked, they will positively assert that their bowels 
are moved daily with regularity ; but probably a very small 
portion of the matter contained is passed, and a large amount 
remains accumulated, which presses against the tender, con- 
gested -ovary as a morsel of food or a filling presses on the 
sensitive nerve of an inflamed tooth and causes the severest 
form of neuralgia. We have not gone deeply into this subject, 
but have been sufficiently explicit to enable any one to under- 
stand this matter so as to prevent it. It is on this account that 



178 MOTHER AND CHILD. 

freely by compound liquorice powder or some such simple 
laxative. Exposure to cold is very apt to bring this on, and it 
is especially liable to occur in girls who sit out of doors after 
dark in their thin summer clothing, and thus allow the damp, 
cool air after nightfall to chill the surface before the expected 
period. This is frequently noticed at the sea-shore or mountain 
resorts. How many of the gayly-dressed beauties, in their 
lightest clothing, will dance a waltz through and then rush 
frantically for a walk on the porch, and will next day suffer 
tortures in their rooms for their imprudence, while their friends 
marvel at the number of sick headaches they seem to have! 
Sleep, rest, — absolute rest in bed, — hot foot-baths prolonged 
and frequently repeated, a strong, hot, well-seasoned cup of 
beef-tea, are the best means of procuring relief. If the pain 
still continue, a hot lemonade with a dessertspoonful of sweet 
spirits of nitre to the tumblerful. The applications to the surface 
of the abdomen are usually valuable on account of their warmth ; 
a mush poultice well sprinkled with laudanum is useful, or a bag 
of hops, quilted, wrung out frequently in hot water and wet 
with the spirits of chloroform. Frequently a hot salt bag to 
the back will give relief, or the rubber bag filled with hot water. 
" In some of the cases, the discharge, having continued for a few 
hours, ceases and then comes on again, while, though scanty, it 
is intermixed with small ' clots.' " 

'In these cases anodynes no longer furnish the ready relief 
which follows their administration in the neuralgic form. 
There are so many causes for this form of dysmenorrhea that 
the physician should at once be consulted, in order that the 
proper treatment may be instituted before the next period. 
Laxatives, such as the various purgative waters, give relief in 
these cases; the granular effervescent Carlsbad salt, a table- 
spoonful in water, may be taken, or a claret glass of Hunyadi 
water, or Friedrichshall water with an equal part of hot water. 
A free purgative action of the bowels should be the first thing 
to accomplish. If the patient is away from a physician, she 
should take a tablespoonful of liquor ammonice acetatis during 



EDUCATION AND SCHOOL-HYGIENE. 179 

the painful time, when the flow is scanty, in some weak, hot 
lemonade every two hours, until three or four doses have been 
taken. Should the pain still remain severe, notwithstanding 
these domestic remedies, the physician should be sent for and 
the matter fully explained to him. 

It is so obviously the mother's duty to be the confidante of her 
child while nature is establishing these physiological processes, 
that we have felt the necessity of adding this chapter to our 
book. Most of the disorders of the nervous system which 
attend this time of life are directly traceable to indiscretions 
which are the result of ignorance. The intellectual girl of 
sedentary habit offends nature by retarding her physical de- 
velopment. The thoughtless enthusiast lays the seed of future 
disorders by an ignorance which the timely admonition of a 
watchful mother would avoid. 



• CHAPTEE XXXY1. 

EDUCATION AND SCHOOL-HYGIENE. 

The question of education is a most important one, and it 
will not be long after the child ceases to need the ever-careful 
watchfulness of its nurse before that problem will present 
itself. The Kindergarten system serves as an admirable initia- 
tion to more elaborate methods, and serves to interest the 
little one while it gradually educates its mind in the proper 
methods of thought, and teaches it to observe, reason, and 
express its thoughts. Education does not mean mere book- 
learning; it enters, or should do so (alas! in how many house- 
holds this part is totally disregarded!), into the training of a 
child from the date of its dawning reason. The mental disci- 
pline from obedience, from example, from proper surroundings, 
constitutes the first great educational step. Unfortunately, in 
this country the ambition of parents or the political manage- 



178 MOTHER AND CHILD. 

freely by compound liquorice powder or some such simple 
laxative. Exposure to cold is very apt to bring this on, and it 
is especially liable to occur in girls who sit out of doors after 
dark in their thin summer clothing, and thus allow the damp, 
cool air after nightfall to chill the surface before the expected 
period. This is frequently noticed at the sea-shore or mountain 
resorts. How many of the gayly-dressed beauties, in their 
lightest clothing, will dance a waltz through and then rush 
frantically for a walk on the porch, and will next day suffer 
tortures in their rooms for their imprudence, while their friends 
marvel at the number of sick headaches they seem to have! 
Sleep, rest, — absolute rest in bed, — hot foot-baths prolonged 
and frequently repeated, a strong, hot, well-seasoned cup of 
beef-tea, are the best means of procuring relief. If the pain 
still continue, a hot lemonade with a dessertspoonful of sweet 
spirits of nitre to the tumblerful. The applications to the surface 
of the abdomen are usually valuable on account of their warmth ; 
a mush poultice well sprinkled with laudanum is useful, or a bag 
of hops, quilted, wrung out frequently in hot water and wet 
with the spirits of chloroform. Frequently a hot salt bag to 
the back will give relief, or the rubber bag filled with hot water. 
" In some of the cases, the discharge, having continued for a few 
hours, ceases and then comes on again, while, though scanty, it 
is intermixed with small ' clots.' " 

'In these cases anodynes no longer furnish the ready relief 
which follows their administration in the neuralgic form. 
There are so many causes for this form of dysmenorrhea that 
the physician should at once be consulted, in order that the 
proper treatment may be instituted before the next period. 
Laxatives, such as the various purgative waters, give relief in 
these cases; the granular effervescent Carlsbad salt, a table- 
spoonful in water, may be taken, or a claret glass of Hunyadi 
water, or Friedrichshall water with an equal part of hot water. 
A free purgative action of the bowels should be the first thing 
to accomplish. If the patient is away from a physician, she 
should take a tablespoonful of liquor ammonice acetatis during 



EDUCATION AND SCHOOL-HYGIENE. 179 

the painful time, when the flow is scanty, in some weak, hot 
lemonade every two hours, until three or four doses have been 
taken. Should the pain still remain severe, notwithstanding 
these domestic remedies, the physician should be sent for and 
the matter fully explained to him. 

It is so obviously the mother's duty to be the confidante of her 
child while nature is establishing these physiological processes, 
that we have felt the necessity of adding this chapter to our 
book. Most of the disorders of the nervous system which 
attend this time of life are directly traceable to indiscretions 
which are the result of ignorance. The intellectual girl of 
sedentary habit offends nature by retarding her physical de- 
velopment. The thoughtless enthusiast lays the seed of future 
disorders by an ignorance which the timely admonition of a 
watchful mother would avoid. 



- CHAPTEE XXXY1. 

EDUCATION AND SCHOOL-HYGIENE. 

The question of education is a most important one, and it 
will not be long after the child ceases to need the ever-careful 
watchfulness of its nurse before that problem will present 
itself. The Kindergarten system serves as an admirable initia- 
tion to more elaborate methods, and serves to interest the 
little one while it gradually educates its mind in the proper 
methods of thought, and teaches it to observe, reason, and 
express its thoughts. Education does not mean mere book- 
learning; it enters, or should do so (alas! in how many house- 
holds this part is totally disregarded !), into the training of a 
child from the date of its dawning reason. The mental disci- 
pline from obedience, from example, from proper surroundings, 
constitutes the first great educational step. Unfortunately, in 
this country the ambition of parents or the political manage- 



180 MOTHER AND CHILD. 

ment of public schools educates children of the working 
classes above their sphere in life. Not for a moment do we mean 
that persons can know too much, but they can obtain a veneering 
of dangerous knowledge by reason of its superficiality, which 
only renders them unfit to assume positions attainable by 
knowledge, and makes them too proud to labor in meritorious 
work beneath their dignity. "Knowledge is power," but <; a 
little knowledge is a dangerous thing." 

Mental and physical development should go hand in hand ; 
overbalance in favor of the first will lead to disease ; of the 
latter, to brutality. A mother should remember that " the boy 
is father of the man ;" the child's early training and discipline will 
be the key-note of its after-life. The lessons of the nursery, by 
its mother's knee, are the beacon light of its conscience in after- 
years ; the seed then sown bears fruit in manhood. " A sound 
mind in a sound body." Dr. D. F. Lincoln thus writes 1 in 
regard to school-hygiene : 

' ; Measured by the standard of the German schools, our chil- 
dren do not have much overwork to complain of. Ten hours 
a day, study and recitation, is a common requirement in gym- 
nasia (classical schools) for boys of ten to fourteen years of 
age; with us the work done in 'high schools' from the age 
of twelve to eighteen varies from six to about seven and a 
half hours for average pupils ; in colleges it is about eight 
hours, and at West Point and Annapolis nine or ten at most. 
These requirements for American schools are not excessive. 
But it is beyond a doubt that we compel younger children to 
attend too long. If a child enters a primary school at five, he 
is kept three hours in the morning and two in the afternoon, 
— or fully two hours too long for his good. He is kept in, 
nominally at work, far beyond the period for which he has the 
power to use his mind at the work. The researches of Edwin 
Chadwick have furnished us with data governing this point, 



1 Keating's Cyclopaedia of the Diseases of Children, vol. iv. We take 
pleasure in quoting freely from this valuable article. 



EDUCATION AND SCHOOL-HYGIENE. 181 

which have never been set aside. He states that a child from 
five to seven years old is able to attend to one subject for 
about fifteen minutes, which should be the length of a lesson ; 
from seven to ten years, about twenty minutes ; from ten to 
twelve years, about twenty-five minutes; from twelve to six- 
teen or eighteen years, about thirty minutes. The total power 
of attention for one day is somewhat in proportion to this. It 
is a disgrace to our communities that they insist on having the 
little ones sent, more to be taken care of than taught, for the 
same number of hours that make a banker's day. Every 
minute in school, after their power of attention is exhausted, 
is given to forming the habit of inattention, which is clear 
loss to education. That health must suffer, is certain. 

" The city of St. Louis fixes the age for admission at seven ; 
but there are numerous kindergartens which take younger 
children. The kindergarten is one of the best charities of 
modern times ; it teaches neglected children habits of neatness, 
order, punctuality, civility; feeds, washes, and clothes them 
when necessary; keeps them half a day in an atmosphere of 
physical purity and health, and must be classed as the best 
evidence of what schools may do for hygiene. On the other 
hand, the kindergartens for children of wealthy parents are 
not wholly free from the charge of over-stimulating their 
pupils. There is a constant tendency among the new teachers 
to urge and arouse children who are doing well enough already : 
I quote the words of a very experienced senior teacher. Some 
children, in fact, are too much aroused, and have to be re- 
moved ; but the danger is understood ; and, on the whole, 
these children also receive moral lessons that are of inestima- 
ble value. 

" The fault of the old-fashioned school was in neglecting the 
pupil's understanding of the subject and his interest in it. 
These points have now been so thoroughly studied that it 
seems as if lesions had become far too interesting for some 
children. A bright boy, making no progress in a common 
school, is transferred to a ' Quincy' school and becomes devoted 

16 



182 MOTHER AND CHILD. 

to study, but he has to be taken out every few months to rest 
his brain. The teacher ought of right to be taken out for the 
same purpose, but she holds out — by the aid of coffee. 

" A very exaggerated notion is entertained by some parents 
regarding the value of primary work : as if children at the 
age of five could be said to be students in the proper sense of 
the word. Schooling at that age means something radically 
different from what comes later. In the words of W". T. Harris, 
' We do not look so much to the gain in intellectual possessions 
as to the training of the will into correct habits, during the 
years previous to the seventh.' l In protest against the popular 
delusion about losing no time, there is an occasional expression 
of individual will, like this : ' I kept my little girl out of 
school till she was eight (or ten) years old, and now she is up 
with the rest.' There is a certain number of bright excitable 
children who are- benefited by this postponement of school-life. 
. . . But the effects of anxiety are worse than those of carrying 
heavy loads. 

" It is a universal complaint among teachers that girls ruin 
their health by social dissipation. The complaint is justified 
by the facts, and it applies to almost all ages in school. The 
fault is in the age we live in, which exacts too much and too 
early display, and expresses the height of its contempt by the 
word ' slow.' 

" The parents of school-boys and school-girls ought to con- 
sider that ' society' has not yet begun for them, — that school 
is entitled to their entire strength ; in return for which, the 
school ought to see that the children grow into the possession 
of firm health. Many boarding-schools deserve praise for 
their success in this matter, and it often happens that children 
of rich and indulgent parents are never quite well except 
when at boarding-school, where regular hours are kept and 
sweetmeats are not allowed to be received from home. A 
return to old-fashioned, English notions about the value of 



1 St. Louis School Eeport, 1872-73, p. 18. 



EDUCATION AND SCHOOL-HYGIENE. 183 

play seems to be making, also, in boys' schools. But it is the 
girls that give most anxiety, because of their readiness to 
undertake double tasks. . . . 

" DYSPEPSIA. 

" This is an established national trait of Americans, and a 
familiar symptom of overwork at school. The first point to 
be noticed here is the fact that it is not (as seems to be popu- 
larly supposed) a local trouble, to be cured by some doses of 
medicine, but a symptom of general want of force in the 
system, to be cured by fresh air, exercise, food, sleep, and good 
regimen in general. 

" The school is responsible for dyspepsia, in some cases, by 
interfering with the pupils' opportuuities for regular meals. 
The old plan gave two hours of free time at noon, during 
which children had a good dinner ; the new plan, already in- 
troduced into high schools and beginning to creep into those 
of lower grade, keeps the child from nine to two o'clock, with 
no food except the wretched ' lunch' of cake and sweets, dis- 
missing him in an exhausted state from the day's work, to 
seek for more cake or pie in the cupboard, or else to await the 
family supper or dinner with what patience he may command. 

" The privilege of having a whole afternoon to one's self is so 
highly esteemed that we shall not probably see a return to the 
old plan. A modification, however, by which an hour's recess 
is given midway in the session affords ample time for the con- 
sumption of a proper lunch, as is the custom in one of the 
Chicago fitting-schools. 

" Children often lose appetite during the course of a school 
year, nor is this always evidence of overpressure, but some- 
times of mere confinement to the house and want of exercise. 
Some, particularly girls, have no appetite for breakfast : they 
must not be allowed to indulge this want of appetite. Yery 
many think it worse to be tardy than to lose a breakfast: 
they perhaps are lazy at times in the morning, or have been 
up late at an entertainment; or they may live a great way 



184 MOTHER AND CHILD. 

from school, and may leave home before the family are quite 
ready for breakfast. Many teachers notice children occasion- 
ally coming to school in a famished state from such causes; it 
is a duty to send them home at once, with advice. 

" Other children there are in whom this failure of appetite is 
a warning to investigate the day's doings. It is fully as bad 
when children acquire a habit of depending on a cup of tea or 
coffee at breakfast. 

" HEADACHE. 

" The causes of headache are as various as those of dyspepsia. 

" If there is distinct excess of mental work, this will often 
produce increased irritability of the brain, and disturbances in 
the circulation of that organ. There is not a very great 
amount of this overwork in our own schools, perhaps. In 
Germany, and in the countries that have formed their educa- 
tional systems upon her models, excessive study is the rule, 
and the result is coming to light in some of the more recent 
statistical reports, as well as in a general popular protest 
against the cruel exactions that are made. . . . 

" The headaches suffered by hypermetropic [far sighted] chil- 
dren are cured at once by suitable (convex) glasses, and by no 
other treatment. The public ought to become aware of this 
rather common class of cases. The patients are literally unable 
to accommodate their eyes for reading without hurtful efforts. 

"NERVOUS DERANGEMENT. 

" The term nervous derangement covers a wide field. One of 
the common forms among school-children is sleeplessness, or 
restless sleep disturbed by dreams. Chorea [St. Yitus's dance] 
is brought on in some predisposed children by school-work. 
Either of these conditions should give instant warning. 

"A fair statement of the general condition of city public- 
school children has been given by I)r. C. F. Folsom: 1 'Pale 

1 Six Lectures on School-Hygiene, Ginn & Co., 1885. 



EDUCATION AND SCHOOL-HYGIENE. 185 

faces, languid work, poor appetite, disturbed sleep, headache, 
and what is vaguely called nervousness, are more common 
among them than they should be among children of their ages. 
I doubt whether there is an exaggerated prevalence of manifest 
or well-marked diseases of the nervous system among them. 
If due to the school-drill, my impression is that they come for 
the most part later in life, after the children have left school, 
and because of constitutions weakened during the school-years, 
instead of strengthened, as they should be.' 

" The impression which the appearance of city school-children 
made on the writer, when a visitor, precisely corresponded 
with the above statement. 

" Some children are extremely sensitive to the influence of 
their comrades. They are unfit to mingle in a crowd; they 
lose the power of expressing themselves in reciting; their 
manner betrays mental pain and constraint. The rigid air of 
discipline in large schools keeps many in an unnatural state. 
Young girls entering college sometimes suffer greatly from 
being obliged to live in the midst of crowds, with so much less 
of personal freedom than young men enjoy under like circum- 
stances. 

" CHOREA. 

" St. Yitus's dance is mainly a disease of the time of bodily 
development : the greater part of the cases occur from the 
sixth to the fifteenth year, which includes the second dentition 
and puberty. It belongs to the class of diseases which may 
spread by psychical contagion among children. Among the first 
symptoms is a change of temper from cheerfulness to fret ful- 
ness or apathy, and along with this the powers of attention 
and memory fail in a way which the teacher may be the first 
to notice. A child suffering from chorea, therefore, is unfitted 
for associating with school-children or performing school-work ; 
and the first step in the treatment must be to remove it from 
school and stop all head-work at home. There is a certain 
number of children who possess a predisposition to complaints 

16* 



186 MOTHER AND CHILD. 

of this sort, and are not fit members of ordinary schools, with 
the strain on the faculties which seems a necessary attendant 
upon our system of large classes and fixed tasks. Such chil- 
dren may develop well, if educated quietly and with much 
open-air freedom. 

f EPILEPSY. 

" Children liable to attacks of epileptic fits are not proper in- 
mates of school-houses. They are often backward, or even 
feeble-minded. They are usually peculiar in temper, — easily 
excited and falling into ungovernable rages, given to lying, and 
licentious. It is impossible to manage them by the ordinary 
course of discipline ; they are not understood by the average 
teacher, and do not belong in the common school, but in those 
special establishments where their nature is understood. Be- 
sides the moral danger to which their presence exposes the 
scholars, the occurrence of an attack in the presence of young 
people is a thing to be greatly dreaded. Fright is a recognized 
cause of epilepsy in well persons ; and a person in a fit is a 
spectacle quite ugly enough to frighten others into fits. Add 
to this the facts that childhood is eminently susceptible to 
nervous impressions, whether of fright or otherwise, and that 
most cases of epilepsy originate in childhood. 

" Of epilepsy as a possible consequence of overwork in school, 
little may be said. The connection 'is not proved, but we 
cannot wholly reject the possibility of it.' l 

" NEURASTHENIA, OR BREAK-DOWN. 

" A complete failure of strength, bodily and mental, is some- 
times the reward of excessive zeal in study. A partial break- 
down, implying a year's semi-illness, with a recovery to one- 
half the former working-powers, is rather common. High 
schools, normal schools, and colleges furnish the cases. . . . 

"Break-down is notoriously common in young women, and 

1 Nothnagel, in Ziemssen's Cyclopaedia. 



EDUCATION AND SCHOOL-HYGIENE. 187 

excess of work or some other distinct cause is usually traceable. 
It may occur shortly after the graduation, rather unexpectedly. 

" BACKACHE. 

" This is not the name of a disease, but is used here as desig- 
nating a class of cases described with admirable vigor by 
Haward, 1 — cases, not of spinal disease, nor of uterine disorder, 
but of over-fatigue. 

" *' It is very common,' says Haward, ' to see cases in which 
such symptoms (backache and weakness of the spinal muscles) 
are the more obvious evidences of over-fatigue, and in which a 
careful examination will reveal other signs of the same evil. 
This is especially the case with young girls of feeble circula- 
tion (evidenced by their cold hands and feet), whose enthusiasm 
for work is in excess of their physical powers. They rise early, 
study before breakfast, sit long hours before the piano or easel, 
or attend long and frequent religious services, retire to rest 
late, take insufficient or innutritious food, and still further ex- 
haust themselves by irregular and fatiguing exercise under- 
taken with the idea of " working off the effect of over-study." 
At last comes the break-down ; the poor girl who has been 
cramming into one day the work of six, and who has been held 
up by the fond and foolish mother as an example of industry, 
piety, and intellectual excellence, finds herself exhausted and 
ill. She cannot sit upright, her back aches terribly, her brain 
feels weak, and in her depression and anxiety she thinks she 
has some serious spinal disease.' 

" DISORDERED MENSES. 

" Painful or irregular menstruation is to be classed with neu- 
ralgia, anaemia, headache, and the like, as a symptom of over- 
pressure. 

" In 1873 a work was published which attracted universal at- 
tention in America, attacking, as it seemed to do, some cherished 

1 Treatise on Orthopaedic Surgery, p. 148. 



188 MOTHER AND CHILD. 

features in American education. The book, Dr. Clarke's ' Sex 
in Education,' was certainly written with the intention of stir- 
ring up discussion; and it succeeded. The author affirmed 
that he had seen vast numbers of women whose health had 
broken down, as he thought, owing to neglect of the menstrual 
function at the formative period, and especially owing to over- 
study, or, rather, uninterrupted study, during this period. The 
purpose was to show that girls needed special care while the 
menses were developing; that the healthy performance of the 
function is so important that no sacrifices are too great which 
further its proper establishment ; that for many girls hard 
study was one of the worst things that could be done during 
the monthly periods ; that a rest was imperatively called for 
by nature, and must be granted ' for a single day, for two or 
three days, or half work for two or three days.' The inference 
drawn from these important truisms was that girls cannot 
stand the strain of working side by side with boys in high 
schools and colleges, where it seems necessary to treat all alike 
on every day of the year. If Dr. Clarke had refrained from 
certain galling expressions, the tone of the rejoinders would 
have been milder ; but his end was attained, and the public was 
the- gainer from the prominence given to the question. 

" The replies made to Dr. Clarke showed that many women are, 
apparently, complete exceptions to his rule in regard to an abso- 
lute need of rest every month. One such exceptional lady, in 
her book, incidentally states that she has stood ten hours a day 
in a store for five years, without the least trouble ; a remark 
which may be improved by us as the occasion of proposing a 
new rule for mixed high schools, — namely, that in the upper 
classes girls ought never to rise in recitation. Opinions may 
certainly differ on the point of rules for school-government, 
but at this day there are many masters who are accustomed to 
make allowance for girls, even to the extent of never giving 
penalties for absence. If this does not meet the case, the 
remedy ought to work through the feminine tact of assistants. 
A little want of tact .may spoil the arrangement ; a word of 



EDUCATION AND SCHOOL-HYGIENE. 189 

complaint about frequent absences may appeal to the pride of 
the girls in such a way that they will accept no more favors. 
It was Clarke's opinion that girls could get through as much 
work as boys, on the whole, ' working in their own way.' 

" The principal of the St. Louis Normal School states 1 that 
' excuses relieving the students temporarily from work are 
granted, whenever asked for on account of sickness, without 
further explanation ; and I may say that it is my belief that 
this privilege has been of great advantage.' The school in 
question is exclusively for young women. 

" CONSUMPTION. 

" There is reason for believing that this disease is rather fre- 
quently caused by school-influences, though it would be hard to 
say how frequently. The story of the cases brings to mind 
those of 'general break-down,' — the familiar 'nervous pros- 
tration ;' the general list of causes is the same, — bad air, con- 
tinued overwork without rest for repair of waste, — and the 
difference in the effect is doubtless largely due to hereditary 
predisposition. 

"Bad air is notoriously influential in causing consumption. 
' The impure condition of the air of our houses, be they fac- 
tories, public buildings, or dwelling-houses, has much to do with 
the great prevalence of such diseases as phthisis pulmonalis, 
bronchitis, and pneumonia, which together make up nearly one- 
quarter of the total mortality. . . . Unventilated and crowded 
workshops and schools are, moreover, the nurseries of strumous 
diseases in general, which sap the strength of the community.' 

" The following observations by Parkes bear upon this point : 
' Usually a person who is compelled to breathe such an atmos- 
phere [vitiated by respiration] is at the same time sedentary, 
and perhaps remains in a constrained position for several 
hours, or possibly is also under-fed or intemperate. But, 
allowing the fullest effect to all other agencies, there is no 

1 Report of Public Schools for 1878-79. 



190 MOTHER AND CHILD. 

doubt that the breathing the vitiated atmosphere of respiration 
has a most injurious effect on the health. Persons soon be- 
come pale, and partially lose their appetite, and after a time 
decline in muscular strength and spirits. The aeration and 
nutrition of the blood seem to be interfered with, and the 
general tone of the system falls below par. Of special dis- 
eases it appears pretty clearly that pulmonary affections are 
more common. Such persons do certainly appear to furnish a 
most undue percentage of phthisical cases, — that is, of destruc- 
tive lung-disease of some kind.' 

" Carmiehael (1810) and Neil Arnott (1832) describe cases 
where the diet of schools was excellent, and the only causes 
for the excessive phthisis were the foul air and the want of 
exercise. In fact, medical testimony lies all in the same direc- 
tion. The presence of dust in the air is a very frequent cause 
of bronchitis, asthma, or pneumonia in various trades, and 
ought to be mentioned here. Consumption has been a terrible 
scourge to the British and other foreign armies, chiefly owing 
to the impure air of the barracks. The same is true of the 
navy; of prisons in general; of monkeys in menageries, and 
other unhappy confined creatures. 

" In America the experience of Prof. H. I. Bowditeh as a 
specialist has led him to utter repeated warnings to the mis- 
guided parents who urge their weakly children beyond their 
powers. The following quotation outlines the history of this 
class of cases : 

" ' A young person, male or female, walks into my study for 
the purpose of consultation in regard to health. I observe 
great paleness of face, extreme emaciation, and trembling steps, 
combined with a slight cough, and evidently more or less diffi- 
culty of breath. These, if combined with a certain intellectual 
expression of the face, almost immediately enable me to fore- 
shadow a history somewhat as follows : 

" ' Stimulated by ambition to be in the front rank of scholar- 
ship, and desiring, owing to poverty or the known wishes of 
parents, to obtain rapidly an education, the poor, scarcely de- 



EDUCATION AND SCHOOL-HYGIENE, 191 

veloped child has beeu laboring for months, always overwork- 
ing intellectually, and at times also physically. Perhaps the 
victim has been carried many miles daily to and from school. 
Study at school, in the cars, and after return at night, some- 
times twelve to fourteen hours, has been the daily rule. [In 
one case the girl went forty miles daily to and from school, in 
all weather, winter and summer.] 

" ' Of course, utter prostration is the result. The appetite 
fails or becomes capricious under severe fatigue and irregularity 
of meals. Gradually a cough is noticed, and it is thought " a 
cold has been taken." . . . 

" 'The cough and the educational race continue on together. 
Finally a failure of strength manifests itself, and then, for the 
first time, the parents begin to look with concern at the ap- 
pearance of their child. But neither child nor parent thinks 
of giving up school. Perhaps it is towards the end of the 
term. " Only a few weeks more," and the coveted prize will 
be gained, and then rest and cure can be attempted. ... At 
last the long-wished-for goal is reached. The first honors are 
gained, but they are now of little comfort, for all strength, 
which has been artificially kept up by the excitement of the 
race, suddenly leave the patient, and the pupil does nothing 
afterwards. . . . All ideas of cure, or even of partial relief, 
have disappeared.' . . . 

" It is important to note that the blame for such abuse of 
life is placed upon the parents, rather than upon any stimulus 
supplied by the teachers. 

" If a child has hereditary tendencies to consumption, it is 
imperatively necessary to select 'a proper, reasonable, well- 
ventilated school (especially one in which the frequent opening 
of windows is avoided). No overwork of mind or body should 
be permitted. If the health fail at all, absolute removal from 
school is required ; travel or anything else should be under- 
taken that will interest and keep the pupil from books and out 
of doors, and let the education, so called, take care of itself 

" In another place the same eminent authority remarks that 



192 MOTHER AND CHILD. 

'in a consumptive family the steadfast rule should be, that the 
mind be wholly subservient to the body's welfare.' 

" In a report on the causes or antecedents of consumption, 
the opinions of two hundred and ten correspondents were 
summed up as follows. The question having been put, ' Is 
consumption ever caused by over-study at school or college ?' 
the answer ' yes' was given by one hundred and forty-six ; 
' yes, indirectly,' by seven ; ' no,' by twenty-one ; ' doubtful,' 
by ten; and twenty-six gave no answer. 

" The circumstance that residence on a damp soil is one of 
the most powerful predisposing agents to consumption ought 
to have its influence when the site of the school-house is 
selected. 

" Here we may end the description of the ailments commonly 
grouped together when the effects of overwork are described. 
Spinal deformity and near-sight are susceptible of being classi- 
fied with these, for weakness is an element in both. It is more 
suitable, on the whole, to describe them separately, on account 
both of their special importance and of their mechanical rela- 
tions to desks and seats. 



"SPINAL DEFORMITIES. 

" Under this heading belong two distinct affections, — lateral 
curvature and round shoulders. With the latter is associated 
the ' hollow back' or excessive curve at the loins. Lateral 
curvature is the object of our present study. 

" Lateral curvature, in the popular eye, is an inelegance of 
person, surmountable by the aid of the dress-maker. The 
physician sees in it a consequence and a cause of low vitality. 

' ; The great majority of cases of this curvature originate in 
children from the age of five or six upward, and in young 
persons who have lately been in school. This might be 
thought a mere coincidence ; for the school-period is necessarily 
the period of development, and the curvature is a disease of 
development. But there is evidence that school work and 



EDUCATIOy AND SCHOOL-HYGIENE. 



193 




customs are genuine causes, — not by any means the sole causes, 
but rather prominent ones. 

•• The origin of lateral curvature depends chiefly on two 
things, — weakness of the muscles which support the spine, 
and bad positions of the body. Weakness, however, is not a 
necessary circumstance, though an extremely common and 
often important one. A bad posi- 
tion constantly maintained will Fig. 17. ' Fig. 18. 
twist the most athletic frame. A 
very muscular person may be forced 
to stand in a one-sided position by 
the circumstance of having one 
leg shorter than the other. Pig. 17 
gives a rough but sufficient idea of 
the way in which the body is sup- 
ported on the legs. If the right 
leg is shortened (Fig. 18), the pelvis (^~^0 
or hip-bone will be tilted to the \_j^yC 
right, and the lower part of the 
spinal column, being firmly attached 
to the pelvis, will tilt with it. If 
the whole spine remained straight, 

the person would be thrown off his balance ; the spine must 
therefore curve to the left at a higher part; and further- 
more, to make up for the overweight thrown to the right 
below, there occurs a ' compensating' curve to the left at 
the height of the shoulders. In addition to this, the spine 
is in parts twisted, with a gimlet-motion ; but this is not 
represented here. 

; - A similar thing happens when children stand on one leg, — 
a position which practically shortens the other leg. • A most 
pernicious habit, and one which is very often to be noticed in 
school-girls (I think I have observed it in girls more frequently 
than in boys), is that while we are talking to them, or during 
recitations, especially if they are much interested in what is 
going on, they are standing on one leg. The position is assumed 
in 17 



194 



MOTHER AND CHILD. 



involuntarily, and it is always, or almost always, one and the 
same leg on which the weight is thrown. The effect of this 
is easily understood : one side of the pelvis is lifted up, curv- 
ing the spine in the loins ; the opposite leg is advanced in 
front of the other, twisting the pelvis and rotating the verte- 
brae. Of course the curve of compensation takes place be- 
tween the shoulders. One is depressed, the shoulder-blade 
gradually projecting, and with the change, and in fact assist- 
ing to produce it, occurs the spiral twist. 71 

" Many curvatures begin in the region of the shoulders ; of 
these, beyond doubt, the cause is largely to be found in false 
positions in writing or drawing. ' I have visited rooms in 
which drawing was taught,' writes Brown, ' where all, — male 
and female, — with scarcely an exception, were sitting in a 
position not only to curve but to twist or rotate the spine, and 
in most the position was such as to produce a triple curve.' 
The deformed attitudes (so to speak) assumed in writing are 

powerfully described by Lie- 
breich. Such occupations can 
hardly be conducted in entirely 
normal postures, but a great 
deal can be done to correct tbe 
grosser faults. One cause of 
the defect is the raising of the 
right shoulder by a high desk 



Fig. 19. 




or table, as is seen in the 
sketch (Fig. 19) borrowed from 
Guillaume. 

" Another frequent cause ex- 
ists when the desk is too far 
from the seat, and the pupil is 
forced to bend over his work 
in an unbalanced posture, which cannot be maintained ; in a 
short time, if not at once, he leans one side forward, puts elbow 



1 Lecture before the American Social Science Association, 1879. 



EDUCATION AND SCHOOL-HYGIENE 195 

on desk or knee, and head on hand, and gets his spine into the 
shape of a corkscrew. 

"It is desirable that every person directing or teaching a 
school should have a notion of the proportions suitable for 
desks and seats. Farther on, this matter is illustrated with a 
few representative figures. Eut it is of the greatest conse- 
quence to remember that no seats or desks can be devised 
which will remove the original iceakness of muscle, which 
ranks as one of the two chief causes, and would by many be 
named as the one important cause. Children cannot be made 
strong by supports. . . . 

" That muscular weakness is a chief cause is further shown 
by the treatment which is successful, consisting essentially of 
prolonged and perfect rest to the weak muscles, by reclining, 
combined with occasional moderate yet active exertion of the 
muscles by appropriate exercises. Cases that are not far ad- 
vanced may do well by using scientifically directed gymnastics. 
Some need never be told that they have ' anything the matter 
with the spine,' provided they can be got to change their habits 
of living. 

" These principles need to be applied to the prevention of spinal 
curvature in schools. The preventive treatment should consist, 
when possible, of very varied muscular activity of an active 
sort, taken at proper times. The best kinds are out-door 
games of an athletic tendency, — leaping, running, coasting, 
skating, climbing, and all sorts of ' hard play.' For boys, 
wrestling, foot-ball, and boxing, and many more, may be 
added, ^o doubt, children must be kept from excesses, such 
as trying to make a high score with the skipping-rope. Some 
sports have a tendency to develop curvature, — croquet, decid- 
edly; tennis, — when played with one hand; base-ball; horse- 
back-riding on a one-sided saddle. Ladies should use two 
saddles, one for each side alternately. Sports liberally indulged 
in are, with this class of exceptions, the usual and natural pre- 
ventive of spinal curvature among boys; if girls played out 
of doors as boys do, they would have little trouble of that sort. 



196 MOTHER AND CHILD. 

" The physical indolence of girls, however we may deplore it, 
is Dot to be overcome at once. It arises in part from their 
unwillingness to assert themselves as boys do ; their readiness 
to submit to custom; and their power of sacrificing comfort 
(i.e., health) for the sake of propriety. The misguided sense 
of decorum, which prevents even walking in many cases, is 
the same feeling that, neglecting certain of the lower func- 
tions of the body, leads to the prevalent habit of constipation, 
and occasionally to disease of the bladder. Every argument, 
therefore, in favor of bodily training, or of the teaching of 
gymnastics in schools, should apply with double force to the 
female sex. 

" The programme of a girl's life consumes the greater part of 
the day in sedentary occupations. Sewing, piano-practice, 
drawing-lessons, embroidery, are among the added burdens of 
the life of girls at home. If parents cannot be induced to 
take active steps for their children's physical training (and 1 
fear they cannot), the school must undertake the task, on be- 
half, at least, of the girls. 

" The existence of spinal deformity has not yet received due 
attention from our public. It is hard to get at the facts. 
There are very few collected observations of masses of chil- 
dren. Parents would dread the exposure of their children ; 
but perhaps the popular mind would not object to a lady sur- 
geon for girls. ~No figures are procurable from female colleges, 
though the very great prevalence of curvature is admitted. 
The late Dr. J. C. Warren in 1830 stated that of the well- 
educated females within his sphere, about one-half were 
affected with some degree of distortion of the spine. It is 
not a wild guess to suppose that this is nearly true at 
present. 

" Spinal curvature is not only a product of low vitality, but it 
does harm by permanently fixing vitality at a low standard. 
The spiromctric observations of Schildbach (Amsterdam, 1862) 
showed that the respiratory capacity of this class of children 
at the ages of from thirteen to seventeen was lessened by one- 



EDUCATION AND SCHOOL-HYGIENE. 197 

third, and in some cases by one-half, — a matter of the gravest 
importance in the maintenance of life. 

" Brown calls attention to the fact that too much mental 
stimulus has an undoubted effect as one of the predisposing 
causes of spinal curvature. Mental rest combined with other 
appropriate conditions will sometimes cure the trouble in its 
incipient stage. 

" The disease may exist in a fully-developed form without any 
apparent change in the direction of the spine as seen from be- 
hind, even when the body is stripped : this is because the 
twisting may be confined to the bodies of the vertebrae, which 
are out of sight. The first thing usually noticed is that "the 
shoulder grows out," or else is higher than the other one. 
The ribs partake, and the chest is twisted out of shape. 

"Patients may sometimes be kept in school who need special 
seats. This is a matter for the surgeon to decide. 

"DESKS AND SEATS. 

" The improvement which has been made in American school- 
desks and seats within half a century is very great. Few city 
schools are now unprovided with ' modern' furniture, which 
in most cases is decidedly better than the old. It is to be 
hoped that the excellence already attained will not stand in 
the way of further progress. We have been quite successful 
in reaching our ideal of comfort ; but we ought not to forget 
that the subject has been much studied, from various other 
points of view, by German and other investigators, and with- 
results which certainly differ from ours. 

"Bad desks are chargeable with aiding the formation of 
two of the most important < school-diseases,' — near-sight and 
spinal curvature. They cause the first by compelling pupils 
to hold the eyes too near the object, and by favoring a stoop- 
ing position at work. Spinal curvature is very much assisted 
by the twisted postures which children take, especially in 
writing. 

" Let it be understood that it is not our object to make desks 

17* 



198 MOTHER AND CHILD. 

and seats which a scholar can occupy with comfort, assuming 
and maintaining one 'normal' position, for hours at a time; 
no, nor for one hour. It is not possible to do this ; and, if it 
were, it must needs injure the child. The discipline of a 
school is a precious thing, but it should not interfere with the 
child's need for change of attitude; nor must the teacher 
fancy that in prescribing fixed attitudes he is following the 
dictates of 'medical science.' Attitudes assumed for a few 
moments, for purposes of respect and attention, may properly 
be formal ; attitudes in study should be decent, but may be as 
varied as possible, subject to correction when they become in- 
jurious. The teacher should be a judge of the latter fact. 
Especially should liberty be given to the younger classes. 
There is indeed a great difference between the mobility of a 
kindergarten and the studious self-possession of a high-school 
class at the age of sixteen or eighteen. 

" Strength cannot be gained by maintaining any one posture, 
unless in the sense that a comfortable posture gives strength 
by resting the muscles. If a comfortable position is given, let 
the child not be kept in it till rest itself is fatigue. 

"As standing is undesirable exercise, so is sitting in a chair 
without a back. It will not make the child's back strong, but 
only causes fatigue, and drives the child to take all kinds of 
unsuitable positions for relief. 

" The young pupil should have a scat and desk so well adapted 
to its form that it will be tempted to take the most correct 
position, as being the most comfortable. It will not keep this 
position long, however comfortable it may be, but it will return 
to it after making its little excursions and changes, and will 
by degrees become accustomed to a normal position without 
much being said about the matter. 

" Little children may properly be taught to sit still, facing 
squarely to the front, for five minutes at a time, when circum- 
stances favor it. They may be taught, by degrees, to sit ten 
minutes, but not through a school-session ; every rest must be 
made up by a corresponding activity, — a change or a move- 



EDUCATION AND SCHOOL-HYGIENE. 



199 



merit, a song or a bit of gymnastic drill. Movement is a 
child's way of resting : rest is a kind of work, to be taught by 
degrees. 

"As regards faulty positions, stooping contracts the chest and 
compresses the abdominal organs. The child, sitting erect, 
and wishing to bow the head towards the book, may be shown 
that a very slight movement will accomplish that object, — a 
hinge-movement at the upper part of the neck, and not at the 
shoulders. The trunk does not need the support of the elbows 
on the desk. One-sided positions easily become habitual, and 
are then exceedingly objectionable : they are chiefly caused by 
propping the arm or elbow on the desk. 

" A comfortable back for the chair is best secured, not by 
giving a series of marked curves intended to follow the natural 

Fia. 20. 




curves of the body, but by giving, first of all, an emphatic 
support to the lower part of the spine. The writer was re- 
cently shown a rather stiff-looking seat, of which the dealer 
remarked that all those who sat down in it at first said ' no,' 
but if he could induce them to remain sitting fifteen minutes 



200 



MOTHER AND CHILD. 



he was sure to sell it. The seat in question has a flat bottom, 
sloping a little down and back ; the back is tilted, and is com- 
posed of two flat surfaces set together at an angle so small as 
hardly to be noticeable, — the projection being one-quarter of 
an inch from a straight line. (See Fig. 20.) This chair, sup- 
porting the pelvis solidly, gives great comfort. A somewhat 
greater projection of the lower middle part of the back might 
be useful. 

" This principle, which the writer is convinced is of the 
greatest value, may be carried out in other ways. The matter 



Fig. 21. 



Fig. 22. 




Liebreich's desk and seat. 



Varrentrapp's desk and adjustable seat. 



is not wholly settled, as may be seen by comparing Figs. 21, 22, 
and 23, given by different authorities. Liebreich's chair (Fig. 21) 
is intended to support the pelvis by following its outline by 
a curve up into the small of the back : the projection of 
the curve may be too great. Fig. 22 (Varrentrapp's), and the 
unshaded spaces in Figs. 23 and 24, give the impression of stiff- 
ness; they come to the height of the elbow, and give support 
solely by a horizontal cross-bar at the top, allowing a little 
open space below the bar. It is noticeable that many of the 
later German plans proposed by scientific men give support in 



EDUCATION AND SCHOOL-HYGIENE. 201 

Fig. 23. 

J 



mm////mi/i 



\ — r 



s n 



Varrentrapp's seat and desk compared with a Boston school-chair aud desk 
(see Fig 25) for corresponding ages. 



Fig. 24. 




American curved-back seat and desk (shaded), and Buchner's pattern, 
for corresponding ages. 



202 MOTHER AND CHILD. 

this way. Their object is to enable the child to sit erect while 
writing, with the aid of a partial support, not necessarily used 
at all moments : it is thought that such a support gives the 
habit of a correct attitude. Buehner was an inspector of 
schools : he says, ' The children very soon feel that the per- 
pendicular piece supporting the small of the back corresponds 
with the structure of the body much better than the slanting 
back which supports the shoulders. I often used to ask the 
children whether they would not like to have a rest for the 
shoulders, as well as for the back, but the girls always an- 
swered in the negative.' Cohn and Fahrner are also in favor 
of the low support. It is of wood, two and a half to three 
inches broad, and long enough to be reached by both elbows, 
which may rest upon it when the child is not writing. It 
must not be placed too high, or it fails to give due support. 

" It may be doubted whether a low back-rest of this kind 
or a slightly-inclined rest for leaning back, supporting shoul- 
ders as well as pelvis, is, on the whole, the better. The present 
writer is not in a position to decide ; yet a choice must be 
made, since it seems impossible to secure a resting-chair which 
shall also give support in writing. 

" The popular American school-seat, with its back curved like 
a long italic /, is not an ideal model. It is comfortable, — at 
least some are, for there are varieties. Some of them let the 
body slide down so that upright sitting is impossible; others 
are too low, which tends to increase the constriction of the 
abdomen ; as a rule, they give the body a round-shouldered 
position, being essentially lounging-chairs with the head-rest 
cut off. Fig. 24 gives a good pattern. 

" Our common wooden chair, with the back-sticks set in a 
curved line, quite fails to support the pelvis; in fact, its defi- 
ciency in this respect is a positive annoyance. Fig. 23 shows a 
chair with this fault. It is built thus to give strength ; this is 
better secured in an old pattern which prolongs the middle 
piece down to the pedestal, following the dotted line, and so is 
able to bring the side-pieces in line with the middle piece. 



EDUCATION AND SCHOOL-HYGIENE. 



203 



"Fig. 21 gives Liebreich's desk and seat, as designed for the 
London School Board. The desk remains the same; the ac- 
commodation for different ages is made by changing the chair 
and moving the foot-rest. The shape of the seat is slightly 
different for the two sexes. The lid is hinged so that it can be 
thrown into a convenient book-holder for reading. In writing, 
the chair is placed so near that the edge of the desk just 
touches the body. The height of the seat is correct when the 
sloping line of the desk, prolonged, just touches the elbows. 

" Fig. 22 gives the design for the desk and seat published by 
the late Dr. George Yarrentrapp, of Frankfort-on-the-Main, 
in the Vierteljahrsschrift fur Gesundheitspflege for 1869. It is 
the one from which the unshaded spaces in Fig. 23 are taken. 
The desk remains the same for different ages ; the seats are of 
different sizes, the dotted outlines corresponding to larger pupils. 

" Fig. 23 gives a side-view, drawn to scale, of a highly-ap- 
proved American school-seat, of a size intended for pupils from 
ten to twelve years old. The position of the lid of the desk is also 
given. The unshaded spaces show the position of correspond- 
ing parts of the model designed by Yarrentrapp, of dimensions 
suited for children of the average height of one hundred and 
forty-three centimetres, which for American children repre- 
sents a little over twelve years. The lower edge of the desk, 
measured from the seat, is 4 J centimetres =1.8 inches higher 
in the American than in the German seat. The German back- 
rest is on a level with the desk, and the pupil while reading 
can easily prop his elbows upon it, maintaining an erect posture. 

" The dimensions, in centimetres, are as follows : 





£< 


&, 












O 


o 


iZ?2 


o^ 


gg 


£~ 




H H 


H « 


K M "t" 


H 5 


2§hm 






B 


£52 
w z a 




ft < 
m 


PL, 


American . . . 


36.9 


64.8 


27.9 


(35) 


30 


5.2 


Varrentrupp . . 


40.2 


63.6 


23.4 


23.4 


23 


2.6 



204 



MOTHER AND CHILD. 



" Fig. 24 gives the side-elevation of two full-sized desk-seats, 
drawn to scale. The American desk is the largest size of one 
of the most popular kinds. To correspond with this, Buchner's 
tables were taken, and the dimensions calculated for a person 
five feet six inches in height ; the lines of desk and seat are 
given with shading for the latter case. The difference between 
the heights of the desks is nearly 4 centimetres = 1.6 inches. 
The difference is increased, practically, by the downward and 
backward curve of the American seat. 

" The dimensions, in centimetres, are as follows : 





o 

S < 


o 






IS 


Seat 
projects 

UNDER 

Desk. 




H 


w 


«« w 


a <j 


Q ^ 




W 


w 


Wcq 


ffl 




American . . . 


43 


76 


33 


(44) 


44 


lor 2 


German .... 


42.9 


72.1 


29.2 


32.1 


23.8^ 


5.2 



" Fig. 25 is the American model from which the drawing Fig. 
23 is taken. The fact that the desk-lid is considerably higher 
than the pupil's elbows is correctly shown. The occupant 
cannot be supported while sitting upright, and when sitting 
back his eyes will be too far from the book for ordinary work. 

" Fig. 26 shows the Belgian model in the Philadelphia Exhibi- 
tion of 1876. It carries out very well the idea of supporting 
the sacrum ; there is a turn-back lid, and the under side of the 
hinged part has a cushion at x for the use of the girls in sew- 
ing ; there is a peg for the hat at o. The seat, however, is 
much too far from the desk. 

" Stooping, cramped, awkward positions are not very likely 
to be assumed in a desk and seat well adapted to the occupant, 
except in the acts of writing, ciphering, and drawing. Bad 
postures in these occupations are far worse than in others, 
from the seeming naturalness with which they are assumed, 
and the certainty with which they become habitual. If a 



EDUCATION AND SCHOOL-HYGIENE. 



205 



child can be taught from the beginning to write in a proper 
attitude, one of the commonest and worst of school-faults will 

Fig. 25. 




Fig. 26. 




be broken up. If there is to be a reform in this matter, let it 
begin at the beginning ; let the youngest classes be the first to 

18 



206 



MOTHER AND CHILD. 



receive the ideal desk (whatever that be), and let the change 
go on, following their progress in the schools. Time ought to 
be devoted to acquiring the habit of sitting well, especially at 
the beginning of school-life. 

" The correct posture in writing is one which does not twist 
the body or neck. The pupil faces the desk squarely; the 
shoulders are equally distant from the lid of the desk ; the 
trunk is erect and nearly touches the desk. The lid must be 
high enough just to support the forearms, but not so high as 
to raise them ; they rest lightly on the lid, but do not sustain 
the weight of the body. This posture cannot at first be main- 
tained long. Perhaps five minutes at a time is all that we can 
expect of beginners; at all events, nothing is more certain 
than that children begin to lapse from this uprightness by 
that time. What can be done then ? The effort to force fifty 
children to keep in one position cannot succeed beyond a brief 
time, and the bad position must not be permitted : hence, as 
soon as fatigue begins, it is best to give a total rest by letting 

the children sit back, stand, etc., 
and then resume writing. 

" The ' systems' of penmanship 
in vogue do not satisfy the de- 
mand here made; they do tend 
to twist the spine. In some cases 
the pupil is directed to turn 
squarely to the left, letting the 
whole right forearm swing over 
the desk-lid, on the elbow as a 
pivot. This raises the right shoul- 
der. In others the direction is 
to turn partly to the left, or 
partly to the right. The posi- 
tions assumed in these cases are 
almost invariably faulty : one or 
the other shoulder is raised; the head leans to the right or 
left, and sinks by degrees until the ear may come in contact 



Fig. 27. 




EDUCATION AND SCHOOL-HYGIENE. 207 

with the hand and the nose almost grazes the paper, the spine 
meantime assuming various curves. 

"Fig. 27 illustrates the position of the manuscript on the 
desk. It is copied (with a little simplification) from an article by 
Staffel in the Centralblatt fur allgemeine Gesundheitspflege, 1884, 
p. 45. If the pupil sits in the correct position, facing squarely 
to the edge of the desk ab, and looking in the direction hg, df 
represents the axis of the right arm,/ being the point of the 
pen and e the place where the wrist touches the paper. The 
left hand steadies and adjusts the paper, and must be near the 
right hand, so that the two forearms point inward and nearly 
meet at the hands. To correspond with this, the paper is 
tilted thirty degrees from the perpendicular, towards the left, 
which enables the hand more easily to follow the direction of 
the ruled lines on the paper. This tilting of the paper is a 
natural device, — the reader has probably often practised it 
without special thought; it is, however, mechanically and 
physiologically the correct plan for easy writing. 

" The letters acquire a slant of thirty degrees when the paper is 
held in this position. This is owing to the fact that the most nat- 
ural and easy way of making down-strokes is to make them par- 
allel to the line gh, — or perpendicular, as the paper is commonly 
held. Children and blind learners begin with these strokes. 

" Some additional points require mention : 

" 1. The chair is often too high for young scholars. The 
most convenient plan may be to provide footstools. 

"2. The seat, from back to front, ought to be long enough to 
support nearly the whole thigh. A more or less spoon shaped 
hollow in the seat is commonly thought desirable. The curve 
of many settees is such as to produce pain at the point where 
the bones (tuberosities of the ischium) rest on the wood : the 
support is not wide enough. 

" 3. Seats must have backs. The straight upright back reach- 
ing to the shoulders is bad ; a straight back slightly tilted is 
not bad. American seats are commonly curved, with curved 
backs, as in Figs. 24 and 25. 



208 MOTHER AND CHILD. 

" 4. The edge of the desks should come up to, or overlap, the 
edge of the seat. The recognition of this fact is a recent dis- 
covery : desks used formerly to be separated from seats by 
a space sufficient to enable the occupant to rise in his place, 
but since desks are now made separate or in pairs, it is only 
necessary to step into the aisle. 

" 5. Most of our best desks are too high, relatively to the seat. 
The reason for making them high is, doubtless, to prevent the 
pupil from stooping. Something is certainly gained in read- 
ing, by this plan, — at least, in convenience of reading, — but it 
interferes with correct positions in writing. The elbows, 
hanging freely, should be only just below the level of the lid. 

" For near-sighted children, the higher desk may be a neces- 
sity in writing. If the desk is made as low as is here recom- 
mended, a portable arrangement resembling a writing-desk 
may be placed on the desk. 

"DISEASES OF THE EYES. 

" Near-sightedness, with some other difficulties, composes one 
of the most important divisions of our subject. To some extent 
the production of myopia is doubtless due to constitutional 
weakness or to depressing causes acting temporarily. Landolt 
considered hardships and poor fare the leading causes, but 
his opinion seems an exaggerated one. Loring has argued 
forcibly in favor of more active sport for growing youth, and 
has shown how confinement to the house, short hours of relax- 
ation, and undesirable fare, must be considered important 
causes of the excessive prevalence of near-sight on the Euro- 
pean continent. 

" Other facts which may illustrate this point are the excess 
of near-sight in cities ; the general prevalence of poor health 
among the same classes of students that are subject to near- 
sight; the readiness with which the eye may be injured by 
work performed before breakfast, during fatigue, or after 
recovery from acute fevers. An associated fact is the low 



EDUCATION AND SCHOOL-HYGIENE. 209 

vitality prevalent among blind people, — which may, however, 
be an effect rather than a cause. 

'• As regards map drawing, the best plan is to use large paper, 
make strong outlines, and insert few details, the object being 
by no means the production of handsome work, but the fixing 
of leading facts on the pupil's mind. In penmanship and 
sewing, and still more in embroidery, harm may easily be 
done. 

" Interesting remarks upon the most desirable form of type 
for clearness are made in Dr. Jeffries's article, Massachusetts 
Board of Health Eeport, 1882-83 : they are from Javal. Many 
school-books are excellent in this respect ; many are still bad. 

" The pupils' most common neglect (says Soldan) is in regard 
to their eyesight. They injure the eye by reading by a lamp 
close to the head, without a shade: the object of the latter is 
quite as much to keep off heat as light. They work in the 
evening instead of by day. They read novels six hours and 
then study two. They defer the most taxing work (such as 
drawing) to the last minute. 

" Light. — Defective lighting is one of the chief faults of 
school-buildings. The difficulty of satisfying the requirements 
in cities is stated under the head of 'Site for Schools.' For 
a northern climate, a very free exposure to sunlight is desir- 
able. Large trees often need removal. If possible, direct 
sunlight should enter every room at some hour of the day. 

" A sufficient light implies light which easily reaches the back 
of the room. Lighting from one side, as practised by the 
Germans, is thought by most of our architects insufficient. 
In fact, a room with sixty scholars and an allowance of two 
hundred and fifty cubic feet of space per head will necessarily 
be too deep for good unilateral lighting. The simplest remedy 
is to make windows on one side and at the back. This prin- 
ciple, carried out, gives us the square school-house with four 
corner rooms on a floor, or, as in the Cleveland model, with 
six rooms on a floor. It has the advantage of natural draughts. 
If the combined size of all the sashes equals one fifth or one- 
o 18* 



210 MOTHER AND CHILD. 

sixth the area of the floor, it is usually said that the supply 
of windows is sufficient. Small windows are not the fault of 
modern school-houses. 

u To get the best effect, windows must reach within a few 
inches of the ceiling. They ought to have square tops, not the 
Gothic shape adopted in the St. Louis model ; they must have 
no heavy projecting outside ornaments to cut off light. In- 
stead of Italian awnings for summer, they should be guarded 
with blinds on the inside. It is hard to find screens that will 
at once exclude the sun's rays and admit enough light and 
wind. Neither white nor yellow nor red screens are pleasant 
when the sun is on them : a neutral gray is best. A neutral 
light tint is suitable for the walls. 

"Lisjhtino; from both sides is well enough for small school- 
houses of one room. There is, however, a preference for light 
coming from the scholar's left hand, especially in writing. 
Rear windows may be added if thought necessary; they give 
a general increase of light: their worst point is that they try 
the eyes of teachers, but that can be relieved in two ways, — 
either by a rather dark shade rolling up from the bottom, or 
by placing the windows about six feet above the floor, so that 
the direct rays do not strike the teacher's eye when looking at 
the class. It is a cardinal rule that no one shall be forced to 
face the windows while reading or otherwise exercising his 
sight: therefore no windows must be in front of the scholars. 
Black-boards are generally put wherever there is room ; those 
between windows ought to be little used ; their surface must 
be a dead black, not glossy. 

" This, however, gives but one aspect of a wide question. 
Other important causes — perhaps much more important — are 
the following. 

"Excessive use, even under favorable conditions, wearies the 
eye. It seems well proved that, in general, students who spend 
longer hours over home lessons are affected by near-sight in 
larger proportion. The practice of working without rest for 
long periods is worse than working many hours with pauses. 



EDUCATION AND SCHOOL-HYGIENE. 211 

"Poor light has always been considered one of the leading 
causes. It not only fatigues the eye, but also induces the pupil 
to bring the eye close to the book. 

" Constant attention to near objects doubtless has its effect, 
even when they are c near' only in the sense of being bounded 
by the walls of streets. City children live in a narrow horizon. 
The youthful eye has a marvellous power of seeing things at 
the distance of two or three inches ; and many things in school- 
life conspire to bring about habits based on this power of adap- 
tation, — badly-proportioned desks, poor type and ink and paper, 
poor light, excess of light. The eye that is laboring at too short 
a distance is enabled to do so by the action of the ' muscle of 
accommodation' in the eyeball, which arranges the focus by 
changing the shape of that organ. Such an eye is working in 
a state of tension, which tends, if long continued, to produce a 
permanent change in the form of the globe, making it longer 
from back to front, which constitutes the chief characteristic 
peculiarity of the near-sighted eye. Yery few, if any, children 
will obey physiological laws of distance without being com- 
pelled to do so. There are certain faults in school furniture 
that favor the bad habit: too great height of desk relatively 
to seat ; separation of desk from seat by an interval, instead 
of having the desk partly over the scat. These, and bad posi- 
tions in writing, have been mentioned already. 

" Anything tending to cause congestion of the eye aids in 
forming near-sight. Among these causes are tight clothing 
(corsets, neckties, collars, belts) ; indigestion, particularly con- 
stipation ; overheated rooms, with bad ventilation ; overwork 
of the brain, especially if it causes headache. Fulness of the 
blood-vessels stretches the eyeball and assists the tendency to 
a change of shape as above noticed. 

"All these influences have their effect chiefly during child- 
hood : few persons become near-sighted after they are grown 
up, though an increase of near-sight is not rare. This circum- 
stance is one of many which warn us that bodily development 
is liable to be impeded or distorted in every direction by false 



212 MOTHER AJSD CHILD. 

education. Every plan which aids in strengthening the con- 
stitution of children may be considered as a contribution to 
the health of their eyes. During childhood the tissues are less 
firm, more elastic, than later in life ; they are more quickly 
renewed, more easily distorted. The geometrical deformity of 
the eyeball is produced by pressure at this tender age. The 
remedy seems to require not only that we lessen the daily 
amount of pressure, but also that we encourage those active 
habits which will make the fibre stronger and more resisting. 

" Hereditary influence is undeniably powerful. What may be 
the effect of several generations of accumulated tendency in 
studious families cannot be predicted : a learned friend of the 
writer's suggests that the result may not be blindness, but a 
permanent type of myopism, in which children will be born 
short-sighted and will not need to become so. But in specu- 
lating about the future it is necessary to take account of other 
tendencies. Far-sight is quite common among children ; and 
the action of inheritance seems not to be limited to the repeti- 
tion of identical defects, but to reproduce both anomalies — the 
long eye and the short eye — with a certain degree of indiffer- 
ence. The existence of a tendency to the normal eye is prob- 
able, independently of the elimination of unfit persons from 
the race. 

" Blindness, or an approach to it, is the tendency of a certain 
number of cases of near-sight ; the retina becomes gradually 
detached from the back of the eye, and becomes incapable of 
receiving exact impressions. On this account (as well as for 
reasons above given) the ' near-sighted eye is a diseased eye.' 

" Test-types, or large cards on which lines of letters of graded 
sizes are distinctly printed, are a ready means of estimating 
the degree of near-sight in the hands of school-principals. To 
give such observations full value, atropine and the ophthalmo- 
scope, in expert hands, are required. A much-used eye is apt 
to be in a state of tension which makes it temporarily more 
near-sighted than it really is ; atropine relaxes the tension. 

" There exists a prejudice against the use of glasses, which is 



EDUCATION AND SCHOOL-HYGIENE. 213 

natural enough. But if near-sight is considerable, so that a 
child really cannot work well in an erect position, it is necessary 
to allow a pair of very weak glasses. The matter cannot be 
determined by directions given in an article like the present : 
the decision and choice must be left to the physician. A limit 
or minimum distance at which the book may be held from the 
eye should be stated, and children advised and corrected of their 
bad practices. The least distance, recommended by the Com- 
mission d'Hygiene des Ecoles of Paris in lS&t, was twenty-five 
centimetres for children in the lowest schools and thirty-three 
for those from eight to twelve years old, — about ten and thir- 
teen inches respectively. Fifteen inches is proper for those of 
larger stature, but would be impossible for little children. 

" Hypermetropic,, or long-sight, is not uncommon among 
school-children. Its effect, when it is of a high degree, is to 
make the act of reading difficult or painful, and sometimes to 
put an end to a child's career in school. Those subject to it 
read fairly well for a time, but after a while become conscious 
of effort in the act of seeing. The eyes feel strained, and the 
letters become somewhat blurred. There is a desire to rest 
the eyes, or to close them firmly, or to compress them with 
the hand. A fresh start is made, and a second rest has to be 
taken after a shorter period. Sometimes the habit of holding 
the book close to the eye is acquired, which makes the case 
seem to be precisely the opposite of long-sight. The choice 
of glasses (convex, or old-sighted) should be directed by a 
competent physician, for the purpose of enabling such children 
to work without suffering. One effect of the disease is the 
production of internal squint. 

" Astigmatism is rather common, and gives as much annoy- 
ance as near-sight. It depends on an incorrect curvature of 
the front of the eyeball (cornea). It is known by producing 
a blurred look in lines that run in one given direction : some 
people see horizontal lines badly, some perpendicular ones ; 
in others there is an oblique axis of indistinctness. If at all 
troublesome, this defect ought to be remedied by glasses, — 



214 MOTHER AND CHILD. 

as it can be perfectly. It is not a disease in the sense that 
near-sight is. 

" PHYSICAL TRAINING. 

" The connection between physical training and general 
education is obvious. The principle being granted, it remains 
for us to consider how much the school and the college of 
to-day should be required to give of their energies to the 
furthering of this end. 

" A system of calisthenics is at present widely used in public 
schools, with distinct benefit. It is not probable that the 
system will ever be abandoned. Most readers must have 
seen the pleasant sight of a roomful of children engaged in 
the simple but vigorous movements of the arms which serve 
so well as vents for superfluous energy. These trained move- 
ments are an indispensable part of primary-school work, and 
are of great use in the intermediate grades, but are of subordi- 
nate value (as now practised) for older pupils. They are quite 
difficult enough for little children, but above the age of twelve 
scholars begin to look down on them as childish, and with good 
reason, for they lack one essential element, — they do not call 
forth exertion to overcome resistance. For better work, 
scholars should have light dumb-bells and wands, and more 
space to use them than can be found in an occupied room. 

" The immediate benefit of exercise, however, does not de- 
pend on any large amount of development that it imparts. 
Yery simple exercises, without any apparatus, practised twice 
a day or often er for five minutes at a time, do a great deal of 
good. Far from breaking up the discipline of the school, they 
make it easier, by relaxing the tension of mind and by 
introducing the element of pleasure. The eyes are relieved 
at the same time. A piano adds pleasure, but is not essential. 
The windows should be opened at the instant the signal is 
given, by having one boy assigned to each. 

" The facility with which calisthenics are practised should 
not blind us to the imperfections of the system. The move- 
ments employed are limited to such as can be safely made in 



EDUCATION AND SCHOOL-HYGIENE. 215 

a room full of desks : the pupils ought to have a much wider 
range of action, in an open hall, large enough for fifty or 
sixty to exercise in. 

" A good type of light gymnastics adapted to use by classes 
is furnished by Amherst College. In that system every student 
is required to attend unless physically unfitted. The work is 
done in classes, to the sound of the piano, under a leader ; 
students attend four days in the week, half an hour at a time. 
Most of the work is done with wooden dumb-bells ; there is 
also considerable running, and some marching. The exercises 
are eminently cheerful ; compulsory attendance meets with the 
acquiescence and support of almost all the students. In fact, 
the exercise is a union of recreation and amusement with work. 

"This moderate amount of exercise is sufficient for nine- 
tenths of the men. For those of unusually muscular frame, 
heavy gymnastic apparatus is provided : for a few, special 
developing apparatus is needed ; all are sufficiently under 
control and observation. No serious accident has occurred 
since the opening of the gymnasium in 1859. 

" The direction is in the hands of Prof. Edward Hitchcock, 
M.D. ; the duties of his position include teaching gymnastics, 
physiology, and elocution as connected with bodily movement ; 
he is expected to be acquainted with the health of each stu- 
dent, and is required to furnish the excuse whenever sickness 
compels a student's absence. The department is dignified by 
marks given for attendance and deportment, and its head is 
a member of the faculty. 

" The object aimed at has always been the promotion of 
health and power of work, rather than the development of 
muscle or the performance of feats of agility and strength. 
As evidence of the success which is attained, Prof. Hitchcock 
states that sickness among the classes diminishes regularly 
from the Freshman year up, being in the Senior year little more 
than half as great as in the Freshman. 

" A system of this sort reaches a large number of young 
men who much need it. Few are so judicious and persevering 



216 MOTHER AND CHILD. 

as to lay down a plan of gymnastics and adhere to it. Much 
of the apparatus in ordinary gymnasiums is unsuited for the 
beginner : its effect is to exhaust and rack his frame and dis- 
courage his efforts. The most complete outfit of apparatus, 
and the best instruction, will not insure the attendance of the 
very class of men who need the training most. Nothing is, 
on the whole, so well suited to the average needs as a class- 
system resembling that of Amherst. 

" At Harvard there is everything except compulsory class- 
work. Careful measurements of the person enable the super- 
intendent, Prof. Sargent, to assign special exercise to each 
young man, defined in kind and amount, for the purpose of 
strengthening his weak points. His apparatus and methods 
have been adopted by a considerable number of colleges,. 
including some for women. 

"A new feature of Dr. Sargent's work consists in taking of 
photographs of gymnasts at the beginning of their course, 
to be compared with those hereafter to be taken on leaving 
college. It has been the writer's privilege to look through 
this list, now numbering several hundred; and it must be 
confessed that the most striking thing about them is the rarity 
of a handsome body, or of even a well balanced and pro- 
portioned body. Deflection of the spine is quite common. 
Athletic oarsmen show, by the twist in their upper backs, which 
side of the boat they are accustomed to row in ; but most of the 
curvatures do not seem to arise from excess of muscle. A preva- 
lent droop of the right shoulder is noticeable. It is thought 
that this may originate in carrying weights in the right hand, 
and perhaps in the musket drill of the public schools. 

" Another noticeable thing is the frequency of the hollow 
back, — a peculiarity of form which may be hereditary, but 
may originate in weakness of the supporting muscles of the 
spine. Weakness of the upper part of the trunk, allowing 
the shoulders to fall forward and the neck to stoop, may be 
the first step, and the saddle-back may be merely the com- 
pensatory curve. 



EDUCATION AND SCHOOL-HYGIENE. 217 

" Smallness of the chest, and consequent want of lung-power, 
constitute a failing that it is really of great importance to 
correct. There can be no safe athletic training for men whose 
chests are small: they run the risk of inflicting permanent 
injury upon heart or lungs by the efforts made with their 
large muscles. It is well known that a small chest predis- 
poses to consumption. Our boys need not be athletes, — it 
would be better for the mass not to attempt to compete in that 
line, — but they ought to have better breathing-capacity than 
they now have. Play is better than any gymnastics, from a 
certain point of view ; but a full allowance of the prevalent 
sports does not give to boys a good chest-development. 

" The late Archibald Maclaren, describing the English school- 
boy as coming under his observation, said, ' I find that almost 
every youth at the time of passing from the schools to the 
University has, as it were, a considerable amount of attainable 
power and material capacity undeveloped ; his body, or rather 
a portion of it, is in arrears in this respect, and as arrears, 
and as a recoverable debt, the youth may fairly view it.' 
During the youth's first term of two months, with properly- 
administered exercise, the chest will expand, in all ordinary 
circumstances, two inches, and in peculiar circumstances he 
has known the increase to reach double that amount. 

"Most sports develop the legs satisfactorily, — walking, run- 
ning, leaping, foot-ball, cricket, fencing, tennis, racket, fives, — 
but some of these give in addition an excess of work to the 
right arm. The result of sports without gymnastic training is 
a frequency of pigeon-breast, hollow breast, drooping shoulders, 
and stooping. There is also an occasional excessive upward 
growth without corresponding expansion of the chest. These 
are the results of abundant play in English schools for the 
better classes, where play is a regular part of the day's busi- 
ness ; they represent the best that a boy's play can do for his 
development. 

"Military drill was brought into favor by the war; its sup- 
posed end is to furnish large numbers of men ready trained to 
k 19 



218 MOTHER AND CHILD. 

service in case of emergency. Some military men find that 
the real result is a conceit of knowledge and indisposition to 
enter the militia. Its best side is the moral side : it raises 
self-respect, and promotes obedience by showing the practical 
need of it. It is, further, as good exercise as many games 
are, and shares with sport the element of interest and pleasure. 
Schools known to the writer have given two hours out of the 
weekly programme to drill, and have found that the week's 
work as a total was not lessened. The objections are that the 
exercise is taken in a cramped position, every movement being 
executed to pattern, and that the number of movements is 
extremely few, so that the exercise is not at all a typical 
one for developing the body ; also, that the musket is too 
heavy, and that it is carried chiefly in the right hand for 
convenience. The so-called setting-up drill consists of light 
gymnastics, the object of which is to give the soldier a good 
position at the outset : this is not and cannot be properly 
carried out in schools unless time is taken, — and the time is 
already taken for musket drill. 

"The amount of time taken by Maclaren to correct the 
shape and growth of boys in his own school was one hour of 
gymnastics weekly, — this, in addition to abundant play. 

" The children in the turner classes practise an hour twice a 
week, somewhat after the general plan of Amherst, aiming to 
give the girls more of grace (e.g., by a variety of dancing 
movements) and the boys more of muscularity. Their work 
is well worth inspecting. 

" The British soldier, on entering the army, is put through 
daily gymnastics from one to one and a half hours daily for 
three or six months. It is unnecessary to describe the practice 
in other armies. 

" In our public schools the friends of reform should not be 
satisfied with less than half an hour twice a week, under 
trained teachers. An hour twice a week might afterwards be 
thought desirable, — the method to be that of light gymnastics, 
to some extent imitating that of Amherst. The teachers may 



EDUCATION AND SCHOOL-HYGIENE. 



219 



be specialists at a moderate salary ; or the work may be done 
by such of the regular teachers as have special gifts for it, as 
is the case in Germany. As regards the amount of work to 
be done, or the teaching force, the city of Frankfort-on-the- 
Main is a good illustration : there are twelve thousand children 
in the public schools of that place, and the number of hours 
given to gymnastics is equivalent to the constant services of 
seventeen and a half teachers. The city has special halls with 
apparatus, of the length of from twenty to twenty-five metres, 
nine or ten metres wide, and from five to five and six-tenths 
metres high. 

" The Routine of a School-Day. — It will not be without 
profit to study the arrangement of time and occupation made 
for cases where a young person's whole time is under control. 
In making the plan it is necessary to have a clear idea of the 
amount of work that is desirable. Time must be assigned for 
play, and for gymnastic lessons : either or both may be made com- 
pulsory (as foot-ball is in some of the great English schools). 

"The following is an outline of a day's work in one of the 
best American boarding-schools for preparation for college : 



Summer. 


WINTER. 


6.30 


7 


7 


7.30 


7.45 


8.15 


8 


8.30 


12.45 


1 


1 


1.15 


2 




2.30 


2.15 




5 


'6* 


6 


6.30 


6.30 


6.45 


6.45 


7 


7 


8.30 


8.30 


9.15 


9.15 


10 


10 



Kise. 

Breakfast. 

Prayers. 

Study and recitations four and three-fourths or four and 
one-half hours. 

Intermission. 

Dinner. 

Study-session in summer one-half hour (none in win- 
ter), then play-time. 

Play-time, summer three and one-half, winter two and 
three-fourths hours. 

Quiet in session, study optional. 

Supper, one-half hour. 

Intermission. 

Prayers. 

Study-session in school-room until bedtime. 

Youngest hoys (twelve and thirteen) go to bed. 

Middle boys (fourteen and fifteen) go to bed. 

Older boys go to bed. 



220 MOTHER AND CHILD. 

"The amount of sleep allowed for is from eight and a half to 
ten and a half hours, according to age and season. The boys 
all have the gift of sleep, and use all the time allowed. Study 
and recitations for the youngest boys, six and a half or six 
and three-fourths hours; for the oldest, about eight hours. 
Play, two and three-fourths or three and one-half hours, ac- 
cording to season, in a solid lump', besides some intermissions 
too short for serious play. There is a twenty-acre lot to play 
in ; in winter they use the gymnasium at their option, under 
control of a tutor. Detention for punishment is assigned to 
the afternoon play-hour : most boys average one hour a week 
at most ; mischievous boys suffer longer detention, but in no 
case to their physical harm. Sweetmeats are not expected to 
be sent from home; if discovered, they are confiscated, 'or are 
served at the boys' table so that many share. 

" Compare with this the routine of a large boarding-school for 
girls, of very good standing, in the same part of the country : 



6.30 

7.10 

8 

8.45 

9 

1 

2.15 

3 

5.15 

6 

7 

7.15 

9 

9.30 



Rise. 

Breakfast. 

Eecitation, forty-five minutes. 

Prayers. 

Recitations and study, four hours. 

Dinner. 

Walk, in which all join. 

Study and recitation, two and one-fourth hours. 

Recreation, — free time. 

Supper, followed by recreation. 

Prayers. 

Study, one and three- fourths hours. 

Bedtime. 

Lights out. 



" Here are nine hours assigned for sleep, and eight and three- 
fourths hours for study ; but three-fourths of an hour is taken 
out every day for gymnastic exercise in classes. All take a 
walk of three-fourths of an hour. There is apparently a con- 
siderable amount of time left free. The contrast between girls 
and boys is seen in the compulsion exercised in regard to all 
exercise, which is doubtless necessary. The required hours of 
work are likely to be too long for some girls ; and if music 



EDUCATION AND SCHOOL-HYGIENE. 221 

and letter-writing and literary societies and prayer-meetings 
are added, girls are likely to be burdened. Yisits to the pupils' 
homes in term-time are properly forbidden. 

"Detention is an effective means of punishment when not 
carried too far ; but when a boy's Saturday forenoon, or even 
his whole day, is spent in silent confinement for a series of 
small faults, the effect is bad, morally and physically. An 
occasional good whipping is far better. 

" The chief objection to corporal punishment is perhaps its 
effect on teachers. Without exactly making them cruel, it 
presents a temptation to hasty and often excessive action, 
afterwards regretted. G-irls should not be punished in that 
way; boys seldom, and with conscientious reflection, without 
anger. 

" The city of Cleveland requires that every case of corporal 
punishment shall be reported to the superintendent of schools, 
in blanks containing the following headings : date ; offence ; 
general character ; home influences ; means employed for 
reform ; whether parents were previously notified of miscon- 
duct, and what answer was given ; whether ever previously 
referred to the principal of the school or the superintendent, 
and how often ; result of punishment. 1 This represents fully 
the present tendency to caution. . . . 

"VENTILATION AND HEATING OF SCHOOL- ROOMS. 

"This subject is admittedly of the first importance. The 
school is the place for work, and bad air at once impairs the 
working-power. More than this, the effect of bad air is to 
deteriorate the whole constitution : there is little exaggeration 
in the statement that all diseases are either caused or are made 
more severe by bad air. Several notorious ' school-diseases' 
are rather closely connected with this cause, — dyspepsia, head- 
ache, nervous debility, anaemia, scrofula, consumption, various 

1 Report of Schools, 187-5-76. 
19* 



222 MOTHER AND CHILD. 

affections of the eyes. — the special discussion of which is found 
elsewhere. 

" The impurities of air may be divided into three classes : 
1, dust, smoke, stenches, gases from heaters, and other defile- 
ments which are independent of the presence of scholars, and 
should be entirely got rid of; 2, carbonic acid from the lungs; 
and, 3, organic matter exhaled from the lungs and skin. The 
last two are unavoidable, and must be allowed for in venti- 
lating. 

" Carbonic acid gas, in the quantity found in ordinary badly- 
ventilated rooms, is not probably of itself a serious source of 
injury. Men who go incautiously to the bottom of wells or 
vats sometimes become unconscious, and perish unless rescued, 
owing to the presence of nearly pure carbonic acid; but in 
rooms the amount present seldom exceeds five or six parts in 
one thousand, which quantity cannot be very actively injurious 
except in so far as it slightly lessens the proportion of oxygen. 
The lethargy of a close lecture-room seems to resemble the 
stupor of asphyxia, but in reality it is genuine sleep, caused 
by heat, bodily fatigue, an easy seat, a monotonous voice, 
weariness from continued passive listening, — all greatly aggra- 
vated by the bad air, no doubt. But carbonic acid by itself 
does not produce the violent symptoms of poisoning which are 
familiar from the description of the ' Black Hole.' Expired 
air freed of carbonic acid does produce such symptoms. The 
eminently noxious agent, then, appears to be, not carbonic 
acid, but the animal exhalations which accompany it in the 
breath. 

" The process of analyzing air for the organic impurities is 
difficult and uncertain. It is therefore necessary to depend 
upon the comparatively easy and certain test for carbonic 
acid, which corresponds quite nearly in proportion with the 
organic impurities and is safely taken as their index. 

" The atmosphere, when pure, contains normally about four 
parts of carbonic acid in ten thousand. Eecent analyses seem 
to indicate that three and a half parts is nearer the truth ; 



EDUCATION AND SCHOOL-HYGIENE. 223 

but it varies somewhat, being larger in cities. Assuming four 
as the rule, the question arises, ' Supposing the air of a room 
to be constantly polluted by breathing, at what stage shall 
we say that it becomes unsuitable for further use?' The 
question is answered variously. Pettenkofer proposed seven 
as a standard of maximum amount of carbonic acid ; Degen, 
six and six-tenths; while Parke, who may be regarded as the 
best authority in our language, sets it at six. That is, the 
permissible added impurities correspond to the addition of 
three, two and six-tenths, or two parts of carbonic acid in ten 
thousand. Parke bases his standard upon the personal expe- 
rience that air at six seems pure, so that a person coming from 
the outer air perceives no trace of odor, or difference between 
the outer air and the room in point of freshness, while if the 
carbonic acid exceeds six the air usually begins to be per- 
ceptibly impure. When it reaches nine or ten the air is what 
is called close and fusty ; above this it becomes disagreeable. 
After a person has been a few minutes in a room the odor 
becomes imperceptible, and he no longer can judge ' by the 
nose.' 

" It is abundantly proved that in our climate, and for large 
bodies of persons, ordinary (so-called 'natural') means of 
ventilation by windows, fireplaces, and holes in walls are 
entirely inadequate, and must give place to the systematic 
use of flues of sizes suited to the supply required. 

" The allowance of fresh air per head is based on the datum 
just given for permissible degree of added impurity. It is, 
unfortunately, the case that the impurity cannot be got rid of 
by itself; it mixes so rapidly with the air that it seems best, 
on the whole, to consider that the mixture takes place at once, 
and that our only remedy is to dilute the air by letting out 
some that is foul and letting in some that is pure. . . . 

"It may be questioned whether children require the full 
supply of air assigned to adults. They are smaller ; the work 
of transformation of material, though active, is in some degree 
proportioned to their consumption of food, which equals that 



224 MOTHER AND CHILD. 

of adults at fourteen, but is much below it at six and eight ; 
they are very active, yet doubtless do not perform as much 
absolute muscular work as adults. Figures quoted in the 
Lomb Prize Essays (page 73) show that children under ten 
expire about one-half as much carbonic acid as adults. . . . 

" Methods of Ventilation. — The heated flue is at present the 
arrangement applicable to the greatest number of cases of 
school-house ventilation. Its size must be determined in ac- 
cordance with the number of pupils in the room or house. In 
most cases one general discharge-flue is sufficient. It should 
be located centrally, so as to lose no heat to the outer air. It 
consists of a straight brick shaft, rising from the cellar to the 
roof, and capped above the roof to protect it from downward 
gusts of wind. To increase the current, the air is warmed by 
having the smoke-flue of the heater pass up through the middle. 
The velocity of the ascending air depends on many circum- 
stances: if the weather outside is cold, if the chimney is high 
if the heat is concentrated, the current is swifter than under 
the opposite conditions. . . . 

" If a pupil requires one-half of a cubic foot per second, every 
square foot in the section of the chimney corresponds to ten 
pupils. A school of four hundred pupils requires a shaft eight 
by ten feet, inside measurement, not allowing for the smoke- 
flue and for space taken up by entering pipes and guards." 

After dwelling at length upon the various methods adaptable 
to the proper ventilation of school-rooms, Dr. Lincoln says, — 

"The preceding is an instance of thorough work. The 
next best thing, for those of limited means, is to avoid blun- 
ders and waste. The following points are offered with this 
purpose. 

'■ Fireplaces are partial remedies for had ventilation. They 
are now occasionally placed in new school-houses, both for this 
reason, and also in the expectation that they will be used for 
fires in mild weather; but the trouble of attending to such 
fires is too great for an average janitor. Their ventilating 
power is small compared with the demand, and maybe roughly 



EDUCATION AND SCHOOL-HYGIENE. 



225 



stated as sufficient for ten persons while the fire is going. As 
a heater the fireplace wastes from seventy-five to ninety per 
cent, of the heat. 

" Stoves arranged like the ' portable furnaces' that are set up 
in cellars are useful. The plan is to place a screen of zinc or 
galvanized iron around the stove, leaving an interval of a few 
inches for an air-space ; a hole in the floor communicating with 
a pipe led out of doors, supplies a current of fresh air under- 
neath the stove, which becomes warmed and rises into the 
room. The screen comes down to the floor ; a valve regulates 
the supply of cold air. 

" Such a stove is shown in Fig. 28, an old design applicable 
to the case of a country school-house. The stove is set at 
a distance from the chim- 
ney, to get more heat from 
the pipe ; the latter ought 
to have a strip of bright 
tin hung below it, to shield 
the heads of the scholars. 
The upper ventilator cools 
the room. 

" Ventilating - stoves of 
various patterns are sold, based on the above principle. They 
cannot supply a quantity of air commensurate with the -wants 

Fio/29. Fig. 30. 



Fig 28 



n. 



** Smoke Flue 



of a school, but they are good as far as they go, and doubtless 
economize fuel. 



226 



MOTHER AND CHILD. 



Fig. 31. 



" Figs. 29-31 show how the principle of ventilating rooms by 
heated flues may be carried out. They are adapted from Mr. 
Jacokes's illustrations in the Seventh Eeport, Michigan Board 
of Health. 

" Fig. 29 shows air entering by a pipe beneath the floor to the 
casing around the stove, which is four inches and six inches 
wide all around. Foul air escapes by the heated chimney. 
The upper outlet requires a valve. 

"Fig. 30 shows the suction of the chimney applied at the 
level of the floor by carrying a pipe down. 

" Fig. 31 combines two stories. An opening in the enlarged 
part of the ventilator in the upper 
story may be utilized for that room. 
u Air- Supply.— The advice has 
been given to make the ventilation 
of a house depend on a single shaft. 
By doing so we avoid the possibility 
of having two shafts ' drawing 
against each other.' Two or more 
shafts, however, of equal height and 
equally heated, need not interfere 
with each other, provided each has a 
full supply of air. This point may 
be overlooked, with bad results, as it 
often is in the chimneys of dwelling- 
houses. . . . 

"As school-houses now are, win- 
dows must be opened. In country districts, especially, both 
sashes ought to move easily up and down. In exposed places 
double windows are applicable; they must not be fastened, 
but must be freely movable. A double pair of sashes with the 
lower outer one raised and the upper inner one lowered gives 
a tolerably safe arrangement. Window-boards are often placed 
under the lower sash, filling the space entirely, the air in this 
case entering by the crack between the two sashes. Or the 
board may be set at the distance of an inch from the lower 




EDUCATION AND SCHOOL-HYGIENE. 227 

sash, in such a way that when the sash is raised two inches 
the air is deflected upward. All such contrivances need to be 
watched closely, or they will occasionally give rise to dangerous 
draughts. 

" It is a good plan to make the curtains roll at the bottom, so 
that the tops of windows can be opened freely in summer 
without injuring the curtains. 

" Pierced window-panes, gauze shields to be placed before 
cracks in windows, Eureka ventilators (little slanting aper- 
tures in outer walls), and a variety of other contrivances, have 
more or less value, but do not meet the Avants of school-rooms : 
if they let in a good supply it causes an unendurable draught. 
No window-supply can be sufficient in cold weather: a crack 
opened in every window and well watched is a proper measure ; 
as a supplementary arrangement it should be an inflexible rule 
to devote five minutes at the close of each hour to some drill 
like light gymnastics, the windows being opened instantly at 
the beginning of the exercise and closed after it. At recesses 
the same should be done, and scholars should be made to leave 
the room. . . . 

" Much has been made of the need for moisture in the air. 
In our climate moisture is so seldom abundant during the 
school-year that a dry in-door air is not noticed as a contrast. 
It is probable that good ventilation, with lowering of the 
prevalent excessive temperature, is what we need to relieve 
the confined, dull, oppressed feelings that are referred to 
'burning of the air by furnaces.' At the same time there is 
some ground for complaint if furnaces are heated excessively 
or leak gas. The gas which escapes is deleterious, for it con- 
tains not only the sulphurous acid which gives it the pungent 
odor, but also some carbonic oxide, which is apt to cause 
headache. The weight of testimony at present goes to show 
that the latter gas is not likely to ' pass through the pores of 
cast-iron furnaces,' either black or red-hot. . . . 

" The temperature of a school-room is commonly required to 
be about 68° F. in our climate; in Europe, about 60°, though 



228 MOTHER AND CHILD. 

there is a difference between places. Judged from the latter 
standard, it is curious to find a regulation in Springfield, 
Massachusetts, that if the temperature does not exceed 60° F. 
half an hour after the opening of school, the class shall be dis- 
missed. In summer there ought to be a regulation for dis- 
missing when the thermometer reaches 82° or 85° F., or some 
point indicating that study is no longer profitable. 

" A warmer for the feet should be placed in the entry-way. 
The writer has seen one large enough for twenty to stand on 
at once, composed of a plate of iron with steam coils under- 
neath. . . . 

" DRAINAGE AND SEWERAGE. 

l } Effects of Air- and Water-Poisoning. — The drainage of a 
building should be strictly scrutinized when there is a suspicion 
that the origin of a 'filth-disease' can be traced to the prem- 
ises. This applies especially to outbreaks of diphtheria or 
other sore throat, pneumonia, dysentery, or diarrhoea, typhoid 
fever, scarlet fever, or measles. 

" Foul smells may cause frequent annoyance, or even head- 
ache and sickness, for years before an outbreak of positive 
disease comes. The tendency of polluted air is to lower the 
general vitality. Air from sewers is ' sewer-gas,' and contains 
a variety of more or less injurious gaseous substances. The 
term 'mephitic poisoning' may be used to denote their bad 
effects. 

" In an extreme degree the effluvia of drains and privies are 
rapidly fatal. In a school at Clapham, England, ' the clearing 
out of a privy produced in twenty-three children violent vom- 
iting and purging, headache and great prostration, and con- 
vulsive twitchings of the muscles. Two died in twenty-four 
hours.' 1 

" ' When the air of sewers penetrates into houses, and espe- 
cially into the bedrooms, it certainly causes a greatly-impaired 

1 Parkes's Hygiene, American edition, 1884, p. 146. 



EDUCATION AND SCHOOL-HYGIENE. 229 

state of health, especially in children. They lose appetite, be- 
come pale and languid, and suffer from diarrhoea ; older persons 
suffer from headaches, malaise, and feverishness ; there is often 
some degree of anasmia, and it is clear that the process of 
aeration of the blood is not perfectly carried on. In some 
cases I have known decided febrile attacks lasting three or 
four days, and attended with great headache and anorexia.' 

" ' The air of sewers passing into houses aggravates most 
decidedly the severity of all the exanthemata, erysipelas, 
hospital gangrene, and puerperal fever; and it has probably 
an injurious effect on all diseases.' (Parkes.) 

" It seems probable that the origin of typhoid fever generally 
depends on the drinking of water contaminated by drainage; 
yet there is reason to believe that drain-effluvia may cause the 
disease. 'In a case mentioned to me by a friend, an outbreak 
of enteric fever in a training-school was localized in certain 
parts of the school (whereas the drinking-water was common 
to all), and was traced to imperfection of traps in those parts 
of the house which were affected. In this case the drains led 
down to a large tank at some distance and at a much lower 
level, and the smell of the effluvia was so slight that at first it 
was not believed that the drains could be out of order.' 
(Parkes.) 

•" 'A marked illustration of disease due to polluted air, when 
the drinking-water was pure, occurred in the school in this 
State, in 1864, where fifty-one out of seventy-seven young 
ladies in the institution were attacked with typhoid fever, of 
whom thirteen died ; three servants also died of the fever. 
The vaults of the privies were shallow, filled to overflowing, 
and emitted a very offensive odor, which at times pervaded 
the whole building. The kitchen-drain discharged its contents 
on the surface of the ground, and a few rods from the school 
there was a foul barn-yard.' The school referred to was the 
Maplewood Institute at Pittsfield. The statement is quoted 
from a circular of the Massachusetts State Board of Health 
for 1879. 

20 



230 MOTHER AND CHILD. 

"The way in which typhoid fever maybe caused by polluted 
drinking-water is well seen in the following case, given by Dr. 
J ohn L. Leconte : 

" The water-supply of a large and prominent boarding-school 
for girls was obtained from a. river, and stored in two cisterns 
under-ground. The cisterns were built of heavy wooden 
curbs, with a timber floor, in which it became necessary tem- 
porarily to make holes, afterwards plugged up. The cisterns 
had brick cemented bottoms and linings, but the plugs pro- 
jected inwardly through this masonry. The plugs were 
removed a year later, without the knowledge of the authori- 
ties, so that the ground- water had free access to the interior. 
Eighteen months later, this mistake (which by itself might 
have caused no harm) was supplemented by placing privy 
vaults outside of the building, one of which was placed eight 
or twelve feet from the cisterns. The vaults were of the sup- 
posed 'tight' kind, with nine-inch brick walls and bottom, 
heavily and carefully cemented, and arched over. 

" In three years from this, typhoid fever broke out. Under 
medical direction, water taken directly from the river was 
substituted for the cistern-water, and the last case of the 
disease occurred ten days after this precaution was adopted. 
As an evidence that the use of the cistern-water was the sole 
cause, it is stated that, although numerous cases occurred 
among the children, and several among the teachers, not one 
occurred among the servants. The latter drank only tea and 
coffee, and very rarely used water, while the children (as 
usual) drank it freely at all times. Among seven absolute 
water drinkers six were attacked by typhoid. 

" Dysentery and Diarrhoea. — There is sometimes difficulty in 
strictly separating these complaints ; they have, moreover, in 
some degree, a common origin, and are spread by the fseces of 
patients infecting the air. More directly to the point is the 
case mentioned by Clouston, where it seemed to be proved that 
dysentery was produced in an (insane) asylum by the exhala- 
tions from sewage which was spread over the ground (a stiff 



EDUCATION AND SCHOOL-HYGIENE. 23 1 

brick-clay subsoil) about three hundred yards from the asylum. 
' The case seems a very convincing one, as the possibility of 
the action of other causes (impure water, bad food, etc.) was 
excluded.' (Parkes.) 

"Diphtheria. — At Groveton, New Hampshire, an epidemic of 
diphtheria occurred in which the centre of infection was the 
school-house. Twenty-two cases broke out among the scholars 
in thirty-six hours, appearing at once in widely-separated 
places ; one hundred and fourteen cases in all, with fourteen 
deaths. There were several circumstances which combined to 
make the school-house dangerous to health. A brook had been 
dammed by the boys so that in rainy weather it ran under the 
school-house, leaving at other times a stagnant pool, There 
was a boggy meadow near by, polluted by privies which had 
not been cleaned for two years. The refuse of a saw-mill and 
tannery was thrown into a mill-pond twenty rods distant ; the 
water was drawn down to repair the dam, causing an intol- 
erable stench ; the outbreak of diphtheria followed, succeeded 
by typhoid fever ; when the pond was kept full, the disease 
disappeared. . . . 

" CONTAGIOUS DISEASES IN SCHOOLS. 

" The diseases against the spread of which by schools it has 
been thought necessary to legislate are (in this country) chiefly 
small-pox, diphtheria, scarlet fever, measles. 

" Whooping-cough, chicken-pox, mumps, G-erman measles, 
are generally neglected in these precautions. Skin-diseases, as 
itch, ringworm, and vermin, are of some consequence, and yet, 
as involving no risk to life, they may be passed over by 
the legislator and left to the care of charity. The same has 
to be said of the far more important disease, contagious oph- 
thalmia. 

" There is abundant evidence of the facility with which these 
disorders are spread by means of schools. This being popu- 
larly known, the first step used to be to propose to close the 



232 MOTHER AND CHILD. 

schools. Probably this has a good effect. But the real point 
to be aimed at, for the good of a community, is outside of 
schools, and consists in isolating the patients. When patients 
are also pupils, the function of the school as a co-worker with 
sanitary authority begins. . . , 

" General Regulations for Preventing the Spread of Conta- 
gious Diseases in Schools. — 1. Persons affected with diphtheria, 
measles, scarlet fever, or small-pox (or varioloid) must be ex- 
cluded from the schools until official permission is given by 
the Board of Health for their readmission. 

" 2. Persons living in the family or house where such a case 
occurs are also excluded until similar permission is given. 

"3. This permission is not to be given until sufficient time 
has elapsed since the occurrence of the last case to insure 
safety, nor until the premises have been disinfected under the 
direction of the Board of Health. 

"4. If a child suffering from one of the above diseases at- 
tends school, the premises of the school must be disinfected 
under the direction of the Board of Health before they are used 
again. 

" 5. Physicians, teachers, school-officers, and school-children, 
knowing of such cases of disease, should at once report them 
to the Board of Health. 

" 6. The Board should also notify the school-authorities of 
such cases. 

" 7. Notice must be sent to the family by the school-authori- 
ties, acting conjointly with the Board of Health. 

' : It is hard to say with certainty how soon a patient may 
safely return to school. . . . 

"The Medical Officers of Schools Association of England, in 
a code adopted January, 1885, name the following periods 
after which pupils who have had diseases may safely return to 
school. 

" Scarlet fever, not less than six weeks from date of rash, if 
desquamation have completely ceased and there be no appear- 
ance of sore throat. 



EDUCATION AND SCHOOL-HYGIENE. 233 

"Measles, not less than three weeks, (f all desquamation and 
cough have ceased. 

" German measles (rotheln, or epidemic roseola), in two or 
three weeks, the exact time depending on the nature of the 
attack. 

"Small-pox and chicken-pox, when every scab has fallen off. 

"Mumps, four weeks from commencement, if all swelling 
have subsided. 

" Whooping-cough, after six weeks from commencement of 
whooping, provided the characteristic spasmodic cough and 
the whooping have ceased, or earlier if all* cough have com- 
pletely passed away. 

" Diphtheria, not less than three weeks, when convalescence 
is completed, — there being no longer any form of sore throat, 
nor any kind of discharge from the throat, nose, eyes, ears, 
etc., and no albuminuria. 

" Ophthalmia, until there has been a complete absence of 
discharge for at least one month, or until the inner surfaces of 
the eyelids are found on inspection to be quite free from gran- 
ulations. . . . 

" Scarlet Fever. — This disease is one of the most destructive. 
It is very contagious. It often leaves behind it very serious 
injuries, even after apparent recovery. To keep children from 
having it is a parent's duty, if possible. An instance of what 
the government may do in the way of checking it is probably 
furnished by the following account. 

"The Boston Board of Health in 1877 established a regula- 
tion requiring children from infected houses to be kept out of 
public schools, and requiring physicians to report their cases 
of scarlet fever. Since that time the number of deaths from 
scarlatina has varied from year to year in the most irregular 
way. But, taking years by groups, it appears that the rela- 
tive number of deaths has much diminished." 

" Dr. J. Lewis Smith 1 refers to the important facts regarding 

1 Archives of Pediatrics. 
20* 



234 MOTHER AND CHILD. 

the propagation of this disease. It is contagious from the first 
day of its occurrence, continues so during desquamation, is 
probably propagated by ear-discharge if disinfectants be not 
used. Its area of contagion is limited, — but a few feet ; on the 
other hand, the tenacity of its poison is remarkable, adhering 
to persons and things, and thus being carried by physicians, 
nurses, visitors, clothing that has been stowed away a length of 
time, letters, library books, and also being retained in the hang- 
ings, furniture, and wall-paper of rooms, etc. The gases gener- 
ated by burning sulphur are proved to be not efficient, although 
Dr. Squibb suggests that it is because they are used in too dry 
a state. The sulphur should be burned in a room, with boil- 
ing water. Chlorine generated by the action of sulphuric acid 
on a mixture of common salt and black oxide of manganese is 
probably more efficient. But Dr. Smith asserts that methods 
for purifying rooms in which scarlet fever and diphtheria 
patients are confined can only be successful if preventive 
measures be employed during the continuance of the case. 
These consist in the use of disinfectants in the sick-room, or 
upon the patient from the beginning of the disease. Isolation 
and disinfection are the measures to be relied upon. The floor 
and walls of the room should be bare ; none but doctor and 
nurse should enter it ; all books, toys, etc., used by the patient 
should afterwards be burned ; soiled clothing should be thor- 
oughly disinfected; thorough ventilation secured; the air 
purified by vaporizing in a broad dish, over a gas or oil stove, 
two tablespoonfuls of the following mixture : carbolic acid, one 
ounce ; oil of eucalyptus, one ounce ; spirits of turpentine, six 
ounces ; the vaporizing to be continued uninterruptedly. The 
body should be anointed every three hours with carbolic acid, 
one drachm; oil of eucalyptus, one drachm; olive oil, seven 
ounces. To the pharynx a solution of corrosive sublimate, 
two grains to a pint of water, may be applied as gargle or 
spray every two hours. It may also be injected into the 
nostrils. Articles of clothing should be disinfected. Physi- 
cians should be especially careful to preserve their clothing 



EDUCATION AND SCHOOL-HYGIENE. 235 

from contamination, and to cleanse themselves thoroughly 
before visiting other patients. They should impress upon the 
family the importance of careful disinfection of the room on 
the termination of the case. In addition to the ordinary 
measures, it is advised to rub the walls of the apartment with 
slices of fresh bread which gather up microbes, and to wash, 
whitewash, or kalsomine the walls, ceiling, or floor with a solu- 
tion of corrosive sublimate." 

The Philadelphia Board of Health has issued the follow- 
ing regulations for the prevention and restriction of scarlet 
fever : 

" Scarlet fever is a highly-contagious disease, directly com- 
municable from one person to another, or by infected clothing, 
rags, etc., or by the discharges from the body of a person sick 
with the disease. It is always attended with a scarlet erup- 
tion on the skin, and is generally accompanied by a sore 
throat. When a child or young person has a sore throat and 
fever, and especially if it has an eruption of the skin, it should 
immediately be separated and kept secluded from all other 
persons except necessary attendants, until it be determined 
whether or not it has scarlet fever, or some other communi- 
cable disease. 

" During the progress of this disease, not only the eruption 
of the skin, but everything that is thrown off from the body 
of the sick, contains the germs or seeds of the disease, which 
are capable of propagating it in another person. The dis- 
charges from the nose and throat are especially dangerous. 
The secretions from the kidneys, which are frequently seri- 
ously affected in scarlet fever, and the discharges from the 
bowels are also supposed to be capable of spreading the poison, 
and this power may be retained for a long time. When these 
secretions have found their way into cesspools, sewers, heaps 
of decaying organic matter, etc., they may be still capable of 
giving off the poison and of spreading the disease. It is, 
therefore, of the greatest importance to destroy the poison 
before it leaves the sick-room. 



236 MOTHER AND CHILD. 

" Attendants upon persons suffering from scarlet fever, and 
also the members of the patient's family, should not mingle 
with other people, nor should children be allowed to enter a 
house in which this disease exists. Children not believed to 
be infected should be sent away from the house in which 
scarlet fever exists to families not liable to the disease ; but 
they should be isolated from the public for at least fourteen 
days from the time of their removal. Children under ten 
years of age are in much greater danger of taking the disease, 
and after they do take it of dying from it, than are grown 
persons. But adults sometimes have the disease, and even 
though it be in a mild form, they may communicate the 
disease in a fatal form to children. 

"In cases of scarlet fever the following directions should be 
carried into effect : 

" 1. Have the patient placed in one of the upper rooms of 
the house, the farthest removed from the rest of the family, 
where is to be had the best ventilation and isolation. The 
room should be instantly cleared of all curtains, carpets, 
woollen goods, and all unnecessary furniture. Keep the r om 
constantly well ventilated, by means of open windows, and 
fires if necessary. Maintain the utmost cleanliness both with 
regard to the patient and in the room. A basin charged with 
chloride of lime, or some other efficient disinfectant, should 
be kept constantly on the bed for the patient to spit in. 
Change the clothing of the patient as often as needful, but 
do not carry it while dry through the house. A large vessel 
(as a tub), containing a solution of carbolic acid, in the pro- 
portion of four fluidounces of clear carbolic acid to the 
gallon of water, or a solution of chloride of lime, in the pro- 
portion of half an ounce of the best chloride of lime to the 
gallon of water, should always stand in the room for the 
reception of all bed and body linen immediately on its removal 
from the person or contact with the patient. Pocket-hand- 
kerchiefs should not be used, but small pieces of rag should 
be employed instead for wiping the mouth and nose ; and 



EDUCATION AND SCHOOL-HYGIENE. 237 

each piece, after being once used, should be immediately 
burned. Two basins, one containing a solution of the purer 
quality of carbolic acid, in the proportion of half a fluidounce 
to the quart of water, or of chlorinated soda, in the propor- 
tion of two fluidounces to the quart of water, and the other 
containing plain water, and a good supply of towels, must 
always be ready and convenient, so that the hands of the 
nurse may be at once disinfected and washed after they have 
been brought in contact with the patient. All glasses, cups, 
and other vessels used by or about the patient should be 
scrupulously cleansed before being used by others. The dis- 
charges from the bowels and kidneys are to be received, on 
their very issue from the body, into vessels containing some 
disinfectant, as a solution of four fluidounces of carbolic acid 
to the gallon of water, or of four ounces of the best chloride 
of lime to the gallon of water, and immediately removed. No 
person should be allowed to enter the room, except those who 
are necessarily attending upon the sick. A sheet moistened 
with a strong solution of carbolic acid, suspended outside the 
door of the ruoin, or across the passage way leading to it, is 
useful to complete the isolation of the patient. 

" 2. Food and drink that have been in the sick-room should 
be at once destroyed or buried. 

" 3. Do not kiss a person who has a sore throat, nor take 
his or her breath, Do not drink out of the same cup, nor 
use any article that has been used by such person. 

"4. For the purpose of preventing the spread of conta- 
gious particles from the surface of the body into the air, 
the skin should be anointed with oil or vaseline, commencing 
on the fourth day after the appearance of the eruption, and 
continuing every day until the patient is well enough to 
take a warm bath. These baths should be given every 
other day for four times, This proceeding should not, how- 
ever, be adopted unless with the advice of the attending 
physician. 

" 5. Boiling is one of the surest ways of disinfecting all 



238 MOTHER AND CHILD. 

contaminated clothing. After the clothing and bedding have 
been immersed for two hours in one of the solutions above 
advised for this purpose, they, should be boiled for at least 
half an hour. Any material which cannot be washed without 
injury should be exposed to a dry heat of about 240° R, 
or fumigated in a closed chamber, as directed below. A hot- 
air disinfecting chamber has been provided on the hospital 
grounds, where beds, woollen goods, etc., may be disinfected 
under the direction of officers appointed by the Board. All 
articles which can be spared should be destroyed by fire. A 
furnace for this purpose has been constructed at the hospital 
grounds, and is at the disposal of the public, under suitable 
restrictions. 

"6. Burial of the dead from scarlet fever should be private, 
and the body should not be exposed to view. Newspaper 
notices of such death should state that the deceased person 
died of scarlet fever. 

" 7. When persons have had scarlet fever, whether they get 
well or die, the room which they have occupied should be 
thoroughly cleaned and disinfected. The paper should be 
removed by moistening with carbolic acid solution, and the 
furniture and all surfaces should be thoroughly washed with 
a solution of clear carbolic acid, in the proportion of two 
nuidounces to the gallon of water, or of chloride of lime, in 
the proportion of two ounces to the gallon of water. The 
walls and ceiling, if plastered, should be whitewashed with 
lime-wash containing the same proportion of carbolic acid. 
The floors and wood-work should be then thoroughly scrubbed 
with soap and hot water. As an additional precaution, fumi- 
gation with sulphurous acid gas may be practised. It should 
precede the washing of the surfaces. Close the doors, win- 
dows, and all other openings, and burn not less than three 
pounds of sulphur for each thousand cubic feet of air-space 
in the room. In order to insure complete combustion of 
the sulphur, it should be used in the form of powder, or in 
small pieces, which should be placed in a shallow iron pan 



EDUCATION AND SCHOOL-HYGIENE. 239 

upon a couple of bricks set in a tub partly filled with water, 
to guard against fire. The sulphur should be moistened with 
alcohol before it is set on fire. Chlorine gas may be used 
instead, and may be generated by pouring strong sulphuric 
acid upon equal parts of common salt and binoxide of manga- 
nese, to which some water has been added. Finally, the room 
should be well aired for several days, by throwing open the 
doors and windows. 

" 8. To disinfect a privy-vault or cesspool, use two and one- 
half pounds of chloride of lime for every eight gallons — or 
about one cubic foot — of fecal matter contained in the vault. 
It should be applied in solution. 

" 9. In regard to food and medicine, always rely on the 
advice of a physician, who should be sent for as early as 
possible." 

" Diphtheria. — Children at school may take diphtheria from 
one another in a variety of ways, — by using the same cup to 
drink from, by the practice of putting pencils and marbles to 
their mouths regardless of whose months they may have 
visited previously, by turning pages of books with wet fingers. 

'"Diphtheria may be diffused by the exhalations of the sick, 
by the air surrounding them, or directly by the exudation, 
communicated in the act of kissing, coughing, spitting, sneez- 
ing, or by the infected articles used, as towels, napkins, hand- 
kerchiefs, etc. The poison clings with great tenacity to certain 
places, rooms, and houses, where it may occasion cases after 
the lapse of months.' 

" These opinions are quoted to illustrate the variety of the 
dangers that attend school-intercourse with an infected person. 
They are also pertinent in view of the doubt entertained by 
some as to the contagiousness of the disease, — a doubt honestly 
held. 

" In epidemics of diphtheria all cases of sore throat must 
be looked on with suspicion, more particularly if the children 
are feverish and depressed. Teachers should take note of 
this. 



240 MOTHER AND CHILD. 

" Contagious ophthalmia is of frequent occurrence in chil- 
dren's asylums, and occasionally in primary schools. It fre- 
quently causes blindness or great injury to sight. Its existence 
among the inmates of an institution as an epidemic is due to 
carelessness about admissions, to overcrowding, poor food, and 
other causes of enfeebled health. One of the chief ways in 
which it spreads is by the children's washing together in the 
same water and using the same towel. 

u Funerals are a fruitful source of contagion. It may not be 
amiss to say that funerals must not be held in the school-house, 
as seems to be a custom in some places. 

" Children who have been exposed to any contagion may be 
ordered to remain out of school for a limited time, in the 
judgment of the Board. 

" Closing school is a measure that seems needless in a place 
where rules about exclusion are well enforced. It seems to 
have a beneficial effect sometimes, as the prohibition of public 
meetings does. 

" It is doubtful if contagious fever is often carried by 
library-books; or, rather, the known cases must be very 
rare. 

" In boarding-schools there ought to be a sick-room in the 
upper part of the house or in an isolated place. A pupil 
attacked with contagious disease should be at once isolated 
and all his effects disinfected. Communication of all sorts is 
to be cut off between pupil and comrades, and great care 
taken about food, clothes, and all things that come from the 
chamber. The parents are to be notified. If a considerable 
number of cases occur, or the disease is malignant, the parents 
of all pupils should be notified, that they nfay remove their 
children if they choose. 

" The school should have its own medical attendant, who is 
to take all steps necessary in epidemics. 

" It may be well to subject pupils to a delay, if when school 
opens it is found that they have been exposed to some con- 
tagious disease. This may prevent an outbreak in the school. 



SURGICAL EMERGENCIES. 241 

The period required may be as follows, dating from the day of 
exposure : 



Diphtheria, 1 2 days. 

Scarlatina, 14 " 

Measles, - 16 " 

German measles, 6 " 



Chicken-pox, 18 dayi 

Small-pox, 18 " 

Mumps, 24 " 

Whooping-cough, 21 " 



CHAPTER XXXYII. 

SURGICAL EMERGENCIES. 

Children are frequently meeting with accidents, or emer- 
gencies of other kinds constantly arise that need immediate 
attention, and the parent or nurse is often obliged to turn 
surgeon for the time being. If one carefully reads at leisure 
moments what doctors call the "indications" for treatment and 
the proper methods of dressing wounds or of antidoting poisons 
or of resuscitating the asphyxiated, when the accident occurs 
he or she will know exactly what to do, and keeping cool under 
such trying circumstances, and doing the u right thing at the 
right time," will require no effort, but will come naturally. 

BRUISES. 

A bruise, which is a contusion of the soft parts, causes a 
rupture of the minute blood-vessels and blood is poured into 
the tissues beneath the skin. This, if not absorbed, will cause 
the " black and blue" appearance so characteristic. Of course, 
the later this color appears the deeper has been the contusion. 

The treatment of a bruise consists in doing all in one's power 
to arrest the bleeding beneath the skin ; thus preventing in- 
flammation, causing absorption of the effused blood, and thereby 
also preventing discoloration in exposed parts of the body. 
Hot water, as hot as can be borne, and continuously applied, is 
the most potent remedy. Ice was formerly recommended ; but 

L' q 21 



242 MOTHER AND CHILD. 

though it will check the bleeding, it congeals the blood al- 
ready poured out and arrests the circulation, thus promoting 
instead of preventing discoloration : so nowadays heat is used 
instead. The part, if possible, should be bandaged, not too 
tightly, and the bandage soaked in a lotion of tincture of arnica 
one part, water three parts, or distillate of hamamelis, or, if very 
painful, one teaspoonful of laudanum to four tablespoonfuls of 
dilute lead-water. If the bruise is in the soft parts, not in a 
joint, and the skin is not broken, the part can be rubbed gently 
but firmly, after the application of a hot lotion, with any oint- 
ment like vaseline, tallow, or soap liniment, or chloroform lini- 
ment may be used instead. If the blow has been in the orbit 
and a " black eye" is feared, use hot water, — not hot enough to 
injure the eye, — and then cover the skin with an " alum curd," 
made by mixing powdered alum with white of egg. 

The bruise of a joint — in other words, a sprain — must be 
treated by heat, as above, and by mild, soothing liniments or 
ointments; it should be loosely bandaged only to give support 
and not to interfere with the circulation, and then the joint 
must be kept at perfect rest till the doctor arrives. If it be a 
limb, it should be wrapped in a pillow and kept elevated, and 
kept moist by cloths wrung out in hot water and covered by 
oiled silk or waxed paper, or if the ankle or wrist be sprained, 
it can be plunged into hot water and kept there as long as 
bearable, this being repeated until the pain is relieved. 

We cannot do better than quote at length from an excellent 
little book by Dr. Howard Barrett l on this subject. 



" CUTS AND OTHER WOUNDS. 

"These are of different. kinds: there is the clean cut, as it is 
called, done with a sharp edged instrument; the lacerated cut 
or torn wound, done with a blunt-edged instrument or torn 
by a hook or other object; the crushed or bruised cut or 

1 The Management of Infancy and Childhood in Health and Disease. 



SURGICAL EMERGENCIES. 243 

wound, as in an injury from a blow with a stick, or a stone, or 
from the fall of a heavy weight ; violent injuries from ma- 
chinery, from being run over, and the like, are usually of this 
class ; and there is the punctured wound, as from the bite of an 
animal, or from some sharp pointed instrument. Just as cuts 
and wounds differ in the way in which they are produced, so 
do they differ in their seriousness, in their way of healing, and 
in the treatment necessary for each. 

" Treatment of a Clean Cut or Incised Wound. — There are 
three principal things to be done : (1) To stop the bleeding. (2) 
To clean the wound and remove extraneous matters, such as clots 
of blood, grains of sand or dirt, bits of glass, etc. (3) To adapt the 
lips of the wound and obtain union of its sides. The first point 
will be fully treated of in the section on the stopping of bleeding. 
The second object is usually accomplished by washing out the 
wound well with a stream of cold water and carefully sponging 
its sides with a soft sponge ; but the majority of clean cuts do 
not need this, because no foreign matter has ever got into them. 
The third point is one of some importance. We should always 
try, if possible, to get the gash to heal by direct union of its 
sides; or, as doctors call it, 'to obtain union by the first in- 
tention.' This is partly a question of good management and 
partly one of good constitution. If the child's constitution is 
healthy, it will be easy to obtain direct union, even if the cut 
is a large one, — he has ' good healing flesh,' as they say. If 
his constitution is weakly and poor, it will be very difficult to 
obtain direct union, even if the cut is only a trifling one. 
Wounds healed by ' the first intention' leave no scar ; those 
healing otherwise usually do. 

" For ordinary small cuts of the fingers or hand, the best plan 
is to bind them up with a narrow strip of dry lint or linen rag, 
applied with moderate tightness and left on for twenty-four 
hours, after which time it may be detached by soaking in warm 
water. Longer and deeper cuts should have their edges brought 
together by strips of plaster, especially if they occur on parts 
of the body where there is space for the use of plaster. The 



244 MOTHER AND CHILD. 

bleeding must first be stopped. Strips of plaster for uniting 
the lips of a wound of any size must be long, and broad enough 
to give support to the edges of the cut. Short, narrow strips 
are useless. Each strip must be attached first on one side of 
the cut, and then (a slight pull being taken on it, by which the 
edges are brought together) to the other. The strips of plaster, 
when once attached, should not be changed, unless they become 
loose ; if they will, let them, remain on until complete union is 
obtained. In taking off strips of plaster from a \voun<), loosen 
both ends at the same time, so that the middle of the strip, and 
not one end, is the last to leave the skin : in this way pulling 
the wound open again may always be avoided. Wounds some- 
times are of such dimensions or in such localities that plaster 
either cannot be used or is not sufficient for the purpose. In 
such cases and in those in which it is necessary to bring the 
edges very accurately together to avoid scar and deformity, as 
in deep and largo wounds of the face, sutures or stitches may 
have to be employed. 

" The necessity of the entire exclusion of air, when we want a 
cut to heal by 'the first intention,' must be borne in mind. 
To this end, among others, we cover it with plaster or wet 
lint, as the case may be. But we possess a valuable agent in 
collodion, 1 a liquid largely used by photographers. If the 
edges of a cut that does not gape much are held together, 
while collodion is painted over them and over a little of the 
surrounding skin also, with a brush ; and if they are so held 
for a few seconds, until the liquid is dry, it will be found that 
a firm, horny film is formed, which holds them in position by 
itself and effectually keeps out the air. The same end is 
attained by tying, or otherwise fixing, a small piece of lint 
soaked in collodion across the cut. in the same manner col- 
lodion may be applied as a sort of air-tight varnish over the 
strips of plaster dressing a wound, or over the spaces of a cut 

1 " It must be remembered that collodion will ' sting' the raw surface, 
so it should not be painted on the edge of a wound. 



SURGICAL EMERGENCIES. 245 

intervening between sutures, or over almost any small wound, 
provided it is done soon after the infliction of the injury, but 
not till the bleeding has entirely ceased. 

" But perhaps, after all, the wound or cut will not heal by 
'the first intention;' it shows no signs of uniting, and begins 
to look rather angry and to pour out either matter or a watery, 
yellowish-red fluid ; or the edges of the wound may become 
red, swollen, and puffy, even though there is no discharge. 
What is to be done ? Eemove whatever dressings, plasters, 
or sutures may have been applied, wash it out with warm 
water, and apply either soft and warm linseed poultices or 
large pads of lint kept soaked in hot water and covered with 
oil-silk, for a few hours. Then keep applied to it cold-water 
dressings, by which is meant linen rag or lint kept constantly 
wet with cold water. In some cases, after all inflammation 
has subsided, the edges may once more be brought together 
by a strip or two of plaster, while a pad of cold-water dressing 
still lies upon them, above the plaster. 

"Deep wounds of the palm of the hand are often dangerous 
from the great difficulty experienced in stopping the bleeding. 
No one but a surgeon can deal with them, but pending his 
arrival the lower part of the arm should be bent as much as 
possible upon the upper, and bound firmly in this position. 
This will have some effect in checking the bleeding. 

" Torn or crushed wounds are usually more serious than 
clean cuts, and are always more difficult to deal with. They 
do not bleed so freely, but they nearly always inflame, and the 
inflammation may go on even to a limited mortification, or 
sloughing, of the wound. The fact of a wound being inflamed 
is rendered evident by the swelled, hot, dry, and glazy appear- 
ance it presents, and by the heavy, throbbing pain felt in it. 
If by chance the inflammation goes on to sloughing, the pain 
and swelling will usually greatly diminish, the wound will 
begin to assume a dark and livid hue, to pour out a thin, 
brownish fluid, and to smell very offensively. The usual prog- 
ress of such a case is for the dead portions of tissue then 

21* 



246 MOTHER AND CHILD. 

gradually to come away, after which the wound slowly fills 
up and heals. 

"Punctured Wounds. — It is very seldom that these will heal 
by c the first intention.' Complete rest of the part, dressings 
of lint, kept constantly wet with cold water, 1 and support by 
a bandage applied with moderate firmness, give the best 
chances of a favorable healing. If the wound, or wounds, 
begin to pour out matter, use hot linseed poultices, instead 
of the cold dressings. 

" Grazes of the skin, or places whence pieces of skin have 
been chipped off, are best treated, if seen very shortly after 
the injury, by just once brushing the surface over with col- 
lodion, carbolated vaseline, or benzoated oxide of zinc oint- 
ment. Either of these protect the surface from the air, the 
former by a hard film, and the latter by a scab, under which 
the skin soon forms again. These remedies are rather too 
sharp, however, for an infant. If the graze has not been seen 
till it has been done some time, or if it occurs in the case of 
an infant, it may be kept dressed with a piece of lint, spread 
with oxide of zinc ointment, which must be changed daily 
till it heals. 

"ON THE STOPPING OP BLEEDING. 

" If, as the result of some accident, a child bleeds rather 
freely, alarm, excitement, and confusion usually reign supreme 
in the house, until the flow is stanched. This may be natural, 
but the alarm is generally groundless, and the excitement is 
mischievous and obstructive of good management. Of course, 
with such tender and fragile beings as infants and young 
children, it is essential that bleeding should be speedily 
stopped; but still the mother may take courage and comfort 
from the assurance that by following closely the advice about 
to be given, she herself may always succeed, on an emergency 

1 " Into which a few drops of creolin have been put. 



SURGICAL EMERGENCIES. 247 

and if no surgeon is at hand, in stopping almost any bleeding 
that is not caused by the wound of an artery ; and even this 
she may often control, until assistance arrives. If an artery 
is wounded, it is known by the blood spouting up in the air in 
successive jets of bright crimson, a jet for every beat of the 
heart. 

" The remedies at our disposal are: (1) Cold, either in the 
form of ice, cold water, or a free exposure to the air, or water 
as hot as can be borne. An excellent plan is to let the hot 
water from the bath-room spigot run over it. (2) Styptics, 
or drugs whose application coagulate and stanch flowing 
blood, such as the strong acid tincture of iron. (3) Pressure, 
either in the form of pads and bandages, or of the finger 
pressed firmly on the bleeding point. (4) Ligature of the part 
injured — if it be the arm or leg, finger or toe — nearer to the 
body than the injury. 

" Of course many other methods are at the command of 
surgeons. 

" What to do. — The first thing to do is to nerve yourself to 
steadiness and self-control, and as far as possible to dismiss 
all alarm as to the amount or continuance of the bleeding. It 
is surprising how much show and mess a little blood will make. 
If the bleeding is rather free, do not attempt to stop it by 
covering it up with rags and handkerchiefs, — this is worse than 
useless, — but expose it freely to the air, and let a stream of 
cold water (the colder the better) or of hot water, and the 
hotter the better, pour over it for a time. This course, if 
persevered in for a time, will nearly always moderate or alto- 
gether stop the bleeding. But supposing that it only mod- 
erates it, or entirely fails to abate it, what then ? Make a 
thick, hard pad of dry lint or linen rag, not much larger than 
the wound, place it upon the bleeding orifice, and bind it 
tightly on with a few turns of calico bandage. If this stanches 
the blood, as it generally will, do not remove it for several 
hours, and when you do, soak it off very carefully in tepid or 
warmish water. If the bleeding continues to go on uncon- 



248 MOTHER AND CHILD. 

trolled, in spite of the pad and bandage, take them off again ; 
wash the wound clean with cold water; make another similar 
pad, but this time steep it in distillate of hamamelis, or 
Pond's extract, and if this fails the strong acid tincture of 
iron (called by druggists liquor ferri perchloridi), if available ; 
if not, in creosote, or in turpentine, or in a strong solution of 
tannin in water ; wipe the wound dry and apply the pad, bind- 
ing it tightly on, as before, with a bandage. 

u If an artery is wounded, the jet of bright blood spouting 
out with each pulsation of the heart, as above described, is 
seen ; and it is never seen unless an artery is wounded. This 
is a most serious accident, and can only be treated by a sur- 
geon, who must be sent for with all spepd. Meanwhile, if 
nothing is done, the child may bleed to death. Binding up the 
wound with a pad and bandage is utterly useless, so are all 
styptics. Cold may do us a good turn ; therefore let the wound 
remain exposed to the air. If the point from which the blood 
spouts can be seen, simply place the finger firmly upon it and 
keep it there unfalteringly until assistance arrives. Bleeding 
from a small artery can thus be held in check for any length 
of time by a sensible person of ordinary nerve ; but if the 
bleeding is from a larger artery (evidenced by large jets of 
blood), or if no one at hand is possessed of sufficient sense 
or nerve, a strong silk handkerchief must be tied so tightly 
round the injured limb somewhere between the injury and the 
body, as to stop the circulation. If the handkerchief cannot 
be tied tightly enough, insert a strong, smooth, round stick 
between the handkerchief and the skin, and twist it round 
imtil it screws the bandage sufficiently tight to prevent the 
flow of blood. If ice can be obtained, place some upon the 
wound; it will tend materially to check the bleeding." 

But as the most important part of the treatment of wounds 
is that immediately following the injury, we will impress upon 
the reader still further the details of their management, and 
quote from Dr. Charles W. Dulles as follows : 



SURGICAL EMERGENCIES. 249 

" DRESSING-MATERIALS. 1 

"Wounds may be rendered aseptic by washing with boiled 
water and sometimes b} T the application of solutions of corro- 
sive sublimate (one to two thousand) or carbolic acid (one to 
one hundred), after which they may be strewn with powdered 
iodoform or naphthalin or bismuth, while pulverized white 
sugar or powdered sulphur may be used for the same purpose. 
After this they are covered with an aseptic layer of gauze or 
absorbent cotton or fine jute, over which is placed an imper- 
vious layer of rubber tissue or waxed paper, the whole being 
retained by a suitable bandage. 

" Such dressings often remain in place until a wound is 
healed, or until some rare accident demands their removal for 
inspection of the wound. 

" Antiseptic gauze is composed of cheese-cloth thoroughly 
boiled and impregnated with corrosive sublimate or iodoform, 
and can be procured at a very moderate price from any 
instrument-maker, or can be made without much trouble. 

" Lint is now used chiefly in making wet applications or to 
hold ointments, when its bulk, softness, and uniform texture 
are of advantage. 

" Absorbent cotton, jute, and fine carded wool are used to make 
and maintain uniform and equable pressure : they are usually 
applied over the dressing of gauze, or over its protecting 
rubber tissue or waxed paper. 

" Bandages are made of soft muslin or flannel, and, as a rule, 
they are more comfortable and easier to apply if of cheap and 
rather open-meshed material. 

" Splints are made of thin metal, very light wood, binder's 
board, or felt fabric. Many useful splints are obtainable from 
the instrument-maker; but there are few cases in which a 
perfectly suitable splint cannot be made out of thin strips of 
pine wood, or pasteboard obtained from boxes or, if necessary, 

1 Keating's Cyclopaedia of the Diseases of Children, vol. iii. 



250 MOTHER AND CHILD. 

from large books. The function of splints is often overesti- 
mated, and a little ingenuity will usually secure satisfactory 
means of fixation and support anywhere. 

" Adhesive plaster, as now in use, is made of resin plaster or 
rubber plaster spread upon strong twilled cotton cloth. The 
latter is often preferable to the former because it does not 
require heat for its application ; but it is less desirable when 
the plaster must remain long on the skin, as it is likely to 
give rise to the formation of an acneform or eczematous erup- 
tion. In removing adhesive plaster dressings, it is especially 
important in the Case of children to remember that it is not 
always necessary to remove all that has been used, and that 
it may suffice to cut through the strips over or near the 
wound, leaving the sides undisturbed, and placing any new 
strips that may be needed over and upon the old ones. Much 
irritation may be saved a patient in this way. It is also well 
to remember that when a strap crossing a wound is to be 
removed, the proper plan is to loosen it from both ends and 
draw on them towards the wound, and never away from it. 
Another little point of importance is that the removal of an 
adhesive strip is less painful, as a rule, if it is done quickly 
and with a steady pull, instead of slowly and by jerks ; also, 
that to pull in the direction of the hairs causes less pain than 
to pull against it. 

"the cleansing op wounds. 
" It is a cardinal point of modern surgery that no wound 
shall be dressed until it is perfectly clean. This rule may 
sometimes be relaxed in cases in which nature has already 
covered a wound with a healthy scab, and sometimes after 
machinery accidents, when the grime which accompanies them 
is very tenacious. But in most cases, and especially in the 
wounds of children, a preliminary cleansing is imperative. 
This can often be effected by touching or pressing the part 
with dry absorbent cotton, or cotton which has been moistened 
and then squeezed nearly dry, or lint, or either of these very 



SURGICAL EMERGENCIES. 251 

slightly moistened ; actual lavement is by no means always 
necessary. When actual washing is required, there should be 
two vessels, one to contain the water and another to receive 
it as it flows from the part. The water may be conveyed 
through a small hose, or may come directly from a spigot, or 
it may be allowed to fall in a steady stream from a sponge or 
a mass of cotton, squeezed in the hand, the size of the stream 
being regulated by the compression, and its force by the height 
at which the hand is held. . . . 

"dressing of wounds. 

" Nature's method of protecting wounds is by the process 
of scabbing ; and when we reflect upon the successful way in 
which this operates in the lower animals, and often in man 
too, we may wonder that it should be almost a matter of rou- 
tine to remove scabs in surgical practice. It may gratify 
our curiosity, it may even aid our study at times, but it is often 
of no advantage to the patient, to remove from a disfigured 
face or a cut head the crusts which are nature's reliable anti- 
septic dressings. It is often well to leave such crusts undis- 
turbed, and, if they are objectionable in an aesthetic sense, 
simply to cover them with something better-looking. An 
artificial scab made with lint, or tarlatan, or thin muslin, and 
collodion, forms one of the best dressings which have ever 
been devised for simple incised and not a few lacerated wounds. 
Many cut heads and simple incised wounds go to a prompt 
and uninterrupted healing under the first dressing of this 
sort. Efficient scabs may be formed by allowing lint to be- 
come saturated with the oozing of a wound exposed to the 
air. Dry powdered borax, or boric acid, or iodoform, may also 
be used to promote the formation of a crust. In all these 
cases, however, it is important to watch lest the crust bind 
down offensive discharges, as any scab may do : when this 
happens, the crust must, of course be removed, and the wound 
cleaned." 

For this reason it is a mistake for an attendant to immedi- 



252 MOTHER AND CHILD. 

ately put adhesive plaster over a wound. A wound, especially 
of the head, should be carefully washed and dressed with a 
dry antiseptic dressing till seen by the doctor. 

"Lead-water and laudanum is but little better than cold 
water, so far as my experience would indicate, although it is 
suited to cases in which there is much heat and pain. This 
dressing ought never to be covered up, as it very often is, 
with impervious coverings. Pure laudanum is often a very 
soothing application. 

"Dilute alcohol is a refreshing dressing, if it be allowed to 
evaporate and be removed at the first sign of pain. 

" The ointments in use in simple surgery are very numerous. 
The best are fresh cold cream, vaseline, oxide-of-zinc ointment, 
and equal parts of this and carbolic-acid ointment. The latter 
are stimulating in their action. A piece of lint or muslin 
should be spread with the ointment and trimmed down to the 
exact size of the sore. If spread on the adjacent skin, it will 
often after a while set up an artificial eczema, very annoying 
to the patient." 

Dr. Dulles in his excellent paper continues as follows, and, 
as the language is clear and forcible, we cannot do better than 
repeat it. 

" EMERGENCIES. 

" The accidents and emergencies to which children are liable 
are different from those of adults, in that there are some to 
which the former are more exposed than the latter, and some 
to which children are not liable while adults are. The most 
usual emergencies in children we will consider, taking those 
which are more or less surgical in their nature and omitting 
those which are purely medical. 

"obstructions to respiration. 

" Drowning, Strangulation, Suffocation. — In cases of drowning, 
if natural breathing has ceased, the first thing to be done is to 
free the body from any clothing which binds the neck, chest, 



SURGICAL EMERGENCIES. 253 

or waist, and to turn it over upon the face for a moment, 
thrusting a finger into the mouth and sweeping it round, to 
bring away anything that may have got in or accumulated 
there. Then the body should be laid out flat on the back, 
with something a few inches high under the shoulders, so as 
to cause the neck to be stretched out and the head to be carried 
well back. The tongue should now be drawn forward out of 
the mouth and held by an assistant, or, if there be no one to 
do this, a pencil or small stick may be thrust across the mouth 
on top of the tongue and back of the last teeth, to keep the 
mouth open and the tongue out of the throat. A very good 
way to get the base of the tongue clear of the windpipe is to 
carry the head well back from the chest and to press the 
angles of the jaw forward with both thumbs applied just be- 
hind the rami [bones] of the lower jaw-bone. 

"To secure artificial respiration the operator should place 
himself on his knees behind the patient's head, seize both 
arms near the elbows and sweep them round horizontally, 
away from the body and over the head, till they meet above it, 
when a good, strong pull must be made upon them and kept 
up for one or two seconds. This effects an inspiration. (Fig. 
32.) The second manoeuvre consists in returning the arms to 
the anterior surface of the chest, and making strong pressure 
against the lower ribs, so as to drive the air out of the chest 
and effect an act of expiration. This need occupy but a second 
of time. (Fig. 33.) Another plan is to hook the fingers under 
the ribs and draw them up firmly, though gently, and then 
release them. 

" If either of these plans is regularly carried out, it will make 
about twenty complete acts of respiration in a minute. It 
should be kept up for a long time, and not abandoned until 
recovery of natural respiration or until the heart has ceased 
to beat. The cessation of the pulse at the wrists must not be 
taken for a sign of death. Often life is present when even an 
acute ear cannot detect the sound of the heart. Deep pressure 
with the finger-ends just below the lower end of the sternum 

22 



254 



MOTHER AND CHILD. 



Fig. 32. 




Fig. 33. 




SURGICAL EMERGENCIES. 255 

may sometimes reveal pulsation in the aorta when it cannot 
be found anywhere else. 

" Wet clothing should be 'removed from a drowned person as 
soon as possible. This can always be done without interrupting 
the artificial respiration or exposing the person. Something 
may be laid over the body and the wet clothes loosened under 
it and drawn down over the feet. Then the body may be 
quickly slipped on to something dry, and covered with some 
other fabric, if the first has become wet, while this, in its turn, 
is pulled away from underneath. 

'• Warmth is to be secured by any means which ingenuity 
may suggest, — hot bottles, or plates, or bricks, or stones, or 
even boards that have lain in the summer sun. At the sea- 
shore there is plenty of hot sand, and often plenty of baking 
bathing- costumes. The body and limbs may be gently, but 
constantly, rubbed towards the heart, to help the blood in its 
labored circulation. None of these things need interfere with 
the efforts to secure respiration, which must be uninter- 
rupted. 

" Some stimulant is to be given as soon as it can be swal- 
lowed. Half-teaspoonful doses of whiskey or brandy, in two 
teaspoon fuls of hot water, may be given every ten minutes, till 
an ounce has been taken. 

"As natural respiration begins to be attempted, it should be 
aided as much as possible by timing the artificial to it. It 
may be stimulated by carefully applying smelling-salts, or 
hartshorn, to the nose, by slapping the skin lightly but smartly, 
or by dashing hot water upon the chest. Where it is available, 
there is no stimulus to respiration better than that of a good 
faradic battery used so as to cause a reflex sobbing, or deep 
breathing, by the pain it causes. Little by little natural 
breathing will take the place of the artificial ; but it must not 
be left un watched for some time. 

" Nothing but danger from cold, or pressing necessity, should 
prompt the removal from one place to another of a child who 
is being resuscitated, before this has been thoroughly accom- 



256 MOTHER AND CHILD. 

plished. If removal cannot be avoided, it must be effected with 
great care. After resuscitation the child should be put in a 
warm bed, being carried carefully* with the head low, and a 
watch should be kept to see that the breathing does not sud- 
denly stop. 

" Where natural breathing has not ceased, all the steps just 
described should be carried out, with the exception of artificial 
respiration. But this should be had recourse to upon the first 
evidence that natural respiration is failing. 

" Strangulation by hanging, or by anything which compresses 
the trachea [windpipe] from the outside, is to be treated by 
re-establishing the respiration in the same way as for droioning. 
The obstruction is, of course, to be removed, and natural 
respiration stimulated or artificial respiration employed. 
Hanging is not an unheard-of accident wiih children, as they 
may hang themselves accidentally, and a child has been known 
to hang a younger one in imitation of what it had heard de- 
scribed by its parents. 

" Suffocation with noxious gases or vapors calls for instant 
removal to the fresh air and for the establishment of natural 
respiration, or of artificial until the natural is re-established, 
as described in speaking of drowning. 

" In strangulation caused by a foreign body in the throat, oesoph- 
agus [gullet], or trachea, it is not always easy to tell which of 
these passages is clogged, but usually there is an active irrita- 
tion, with coughing, when a foreign body lodges in the larynx 
or trachea, while swallowing can be done quite readily. On the 
other hand, when the oesophagus is stopped it is usually im- 
possible to swallow, and there is little or no tendency to cough, 
no matter how much the breathing may be interfered with. 
Foreign bodies in the fauces or larynx are not so hard to 
discover. 

" If a foreign body be within reach of the fingers, it may 
often be easily removed. If not, a pair of forceps may be 
used, or, in a pinch, a pair of blunt-pointed scissors. Or a 
hair-pin may be straightened out and one end bent round so as 



SURGICAL EMERGENCIES. 257 

to make a loop, and this used to dislodge the foreign body ; or 
the handle of one blade of a pair of scissors may be used in 
the same way. It has been stated that for foreign bodies in 
the throat, such as pieces of meat, etc., a simple mode of re- 
lief is to blow forcibly into the ear. This sometimes excites 
powerful reflex action, during which the foreign body is ex- 
pelled. Such a plan is so easy of execution that it is certainly 
worth trying. 

' ; Children not infrequently get buttons, coins, or marbles in 
their throats. These may be often pulled out or expelled by 
vomiting induced by titillation of the fauces, or by an ordinary 
emetic. Holding the body up by the legs, with the head 
hanging down, may sometimes aid other eiforts to get rid of 
such things. Attempts to push the foreign body down may 
prove successful. 

" If foreign bodies get into the larynx or trachea, a moderate 
blow on the back with the open hand, or a quick strong 
squeeze of the chest, sometimes aids the coughing act ; and 
inverting the body may assist in dislodging the foreign body 
if it be not too tightly wedged in. 

" When coins, marbles, slate-pencils, or nails are swallowed by 
children, it is usually a mistake to give an emetic or a purga- 
tive. The proper plan is to let the bowels alone and to give 
plenty of good solid food, especially vegetables, so that the 
foreign body may be surrounded with the waste and carried 
out of the body without injuring the walls of the intestines. 



" FOREIGN BODIES IN THE EYE, NOSE, AND EAR. 

" Foreign Bodies in the Eye. — Small substances, like cinders, 
dust, or small chips of stone or metal, can often be removed 
from the eye by very simple means. Sometimes the flow of 
tears washes them out. At other times catching the upper 
lid by the lashes and pulling it away from the eyeball and 
down over the lower lid, then letting it go so that as it recedes 
its under surface is swept by the edge of the lower lid, will 
r 22* 



258 MOTHER AND CHILD. 

clear it out. If this does not prove successful, a loop made of 
a horse-hair or of a long human hair can be passed under the 
lid and swept from the outer side towards the nose and drawn 
down. This may serve the purpose. If it does not, the upper 
and lower lids must be everted and examined with a good 
light and the aid of a lens if necessary. 

" The eyeball must also be examined and an} T foreign sub- 
stance removed. 

" One must be on his guard against the sensation which is 
sometimes left after a foreign body has been removed from the 
eye. But a most careful search should be made before this is 
taken to be a self-deception. 

" After removing a foreign body from the eye, the irritation 
may be sufficient to demand cool, wet applications, or even 
anodynes. Nothing is better than a thin mucilage of pure, 
clean gum-arabic poured freely in the eye. A bandage loosely 
applied often does much good. 

" When lime gets in the eye, the eye should be deluged 
with water, and a little vinegar or lemon-juice and water (a 
teaspoonful of vinegar or lemon-juice to a teacupful of water) 
poured over the eyeball. 

"Foreign Bodies in the Nose. — Children sometimes place, 
or have placed, in their noses small bodies, such as marbles, 
buttons, peas, beans, or small grains. To get rid of them the 
nose should be blown hard, or sneezing may be excited by 
tickling the nose or giving snuff, or the child may be told to 
take a full breath and then be given a smart blow on the 
back. Some one of these plans may dislodge the foreign body. 
If it does not, the affected nostril may be closed while the 
other is blown into, through a rubber tube, and on suddenly 
releasing the closure of the side occupied by the foreign body 
it may be driven out. If none of these methods succeed, 
instrumental extraction will be required. 

" Foreign Bodies in the Ear. — The removal of foreign bodies 
from the ear is so delicate an operation that, when possible, a 
specialist should be asked to do it. . . . 



SURGICAL EMERGENCIES. 259 

" If live insects get into the ear, oil or glycerin or salt-and- 
water should be poured in. Or a plug of cotton soaked in a 
strong solution of salt and vinegar may be placed in the ear 
and the head turned over on that side. A method which has 
sometimes been successful is to turn the ear to a bright light, 
so as to tempt the insect to back out. 



" LOSS OF CONSCIOUSNESS, AND CONVULSIONS. 

" The treatment suitable for all cases in which there is doubt 
as to the cause of unconsciousness is to secure quiet and rest, 
the body being laid upon the back, with the head a little 
raised. If there be great paleness and a cold surface, with 
slow, sighing breathing, — the signs of prostration, — smelling- 
salts or hartshorn may be held under the nose, hot tea or 
coffee given, and heat applied to the body. If there be great 
heat of the surface, cold may be applied to the body and head, 
and cold drinks given. 

" Fainting. — A fainting person must be laid out flat at once, 
so that the heart may not have to work against the force of 
gravitation in sending blood to the brain. Sprinkling water 
upon the face and holding smelling-salts to the nose tend to 
excite the nerves of sensation and rouse the brain and heart 
to renewed activity. Nothing else is usually necessary ; 
though if a person is very slow in coming to, it may be well 
to apply heat in the form of a mild mustard plaster or hot 
moist cloths to the pit of the stomach. 

" Hysterics are best treated by the exercise of calmness and 
patience, sometimes by taking no notice of the attack, or by 
leaving the sufferer in a room alone. Heroic measures, like 
dashing water into the face, are not to be generally recom- 
mended. Good is sometimes done by giving valerian or Hoff- 
mann's anodyne. 

" Epileptic fits are to be treated very much like fainting-fits, 
because in them also the brain is temporarily bloodless. At 
the same time, any movements calculated to injure the person 



260 MOTHER AND CHILD. 

must be controlled. There is no use in struggling against 
such as will do no injury ; they had better be simply regulated, 
and no attempt made to prevent them entirely; but a piece 
of folded cloth or a piece of soft wood may be— if it can be — 
thrust between the teeth, to prevent the usual biting of the 
tongue. When the height of the convulsion is passed, rest, 
quiet, and perhaps a moderate stimulation may be secured. 
Here again the flat position of the body must be main- 
tained. 

" Convulsions of children and infants are generally (in the 
absence of brain- or kidney-disease) due to some irritation of 
the digestive ajjparatus or to teething. They are usually pre- 
ceded by some other evidence of irritation, such as restlessness 
and fretfulness. The spasms may affect the whole body at 
once, or only a half, or only one limb at a time. The eyeballs 
sometimes roll about or squint, or, they are turned far up, so 
that only the lower part of them can be seen, 

"When convulsions occur, the child should have cold ap- 
plied to the head and heat to the body. It often seems to do 
good to place it in a tub of hot water to which some mustard 
has been added. A large injection of hot soapsuds should 
also be given, to clear the bowels out, and, if possible, an 
emetic, in the hope of removing any cause of trouble from the 
stomach. . . . 

"injuries to the brain. 

" Concussion of the brain may be caused by blows or falls on 
the head, or even by falls upon the feet or the buttocks. In 
such cases there is sickness, sometimes fainting, with paleness 
and depression. There is also usually confusion of ideas, and 
the sufferer cannot talk continuously and coherently. There 
may even be unconsciousness. 

"The proper treatment for this condition is rest in bed, 
quiet, and plenty of fresh air. If the skin becomes cold and 
clammy, heat should be applied to the body and limbs. No 
whiskey or brandy should be given. . . . 



SURGICAL EMERGENCIES. 261 

"EFFECTS OF HEAT. 

" Burns or scalds are usually dangerous in proportion to 
their extent and depth. Those which involve as much as half 
the surface of the skin are almost necessarily fatal. 

"After an extensive burn or scald, so much of the clothing 
as has to be removed must be clipped away, so as not to burst 
blisters that have formed. These may be punctured at one 
edge and their contents allowed to run out, and the elevated 
cuticle to fall down upon the deeper layer. Then a dressing of 
pure sweet oil, castor oil, or vaseline is to be applied on strips 
of soft old linen, and disturbed as little as possible afterwards. 
Iodoform is a very soothing application to burns, either in 
powder or in an ointment ; although its prolonged use has a 
tendency to promote or prolong suppuration. Carron oil [lin- 
seed oil and lime-water, equal parts] is also an excellent appli- 
cation, and stimulants or anodynes may be given as required. 
In case of a severe and extensive burn, the entire body may 
be immersed in a bath, to be kept at a temperature of 100° F. 

" Slight burns or scalds are best treated by applying a cloth 
soaked in a strong solution of baking-soda — the bicarbonate — 
in the proportion of a heaping tablespoonful in a teacupful of 
water, or it may be powdered on without using any water. 
Carron oil is a good application for such burns. So is the white 
of egg. In an emergency damp earth may be used, or white- 
lead paint. Anything may be used which will prevent friction 
and exclude the air; but nothing should be used which will 
stick in cakes and prevent after-examination or make this very 
painful. For this reason flour and cotton batting, though often 
recommended, had better not be used. For small burns, simple 
cool water is better in every way than these. Indeed, for any 
but the most extensive burns it is one of the best remedies : 
an arm or a leg can be immersed in it and left there a long 
while with great advantage. 

"Burns with acids must be deluged with water and then 
ti'eated like other burns. 



262 MOTHER AND CHILD. 

"- Burns with caustic alkalies, such as soap-lye, should be treated 
with an application of vinegar, followed by applications of 
oil. 

" Burns with Sot Pitch. — After such burns the pitch often 
sticks. In such a case it ought not to be removed immediately 
unless in excessive amount. 

" Sunburn, and the burns caused by external applications, like 
mustard, may be treated very successfully with bicarbonate of 
sodium. This may also be mixed in equal parts with vaseline, 
cosmoline, or lard from which the salt has been boiled out, and 
used as an ointment. 

" Sunstroke, or more properly heatstroke, is not usually due to 
the direct rays of the sun, but rather to a prolonged elevation 
of the bodily temperature, especially in confined places. When 
it takes place in the open air it is apt to be on oppressive, 
heavy, or murky days. It is generally preceded for some time 
by pain in the head and a sense of oppression. The attack, 
however, culminates in loss of consciousness, with heavy, 
labored breathing, and an intense burning, dry heat of the 
skin, while the bladder and bowels are often involuntarily 
evacuated. The absence of perspiration in the presence of so 
great heat is one of the most characteristic symptoms of heat- 
stroke. 

" The treatment consists in first lowering the temperature. 
As much of the clothing as practicable must be removed, and 
the patient should be transported to a cool and airy place, if 
possible. Cold must then be applied to the head and body 
and ice may be rubbed over the chest and placed in the arm- 
pits. Pouring or dashing cold water over the body is not to 
be advised, as it conveys a needless shock to the system; but 
there is nothing better than to place the body in a cold bath, 
or to wrap it in sheets kept wet and cold by renewed appli- 
cations of cold water or ice. The temperature of the body 
must be watched, as there is some risk of pushing its reduction 
too far. When the temperature has been brought down to 
100° F. or consciousness has returned, the cold may be discon- 



SURGICAL EMERGENCIES. 263 

tinued, to be renewed only if the surface becomes again very 
hot. 

"Heat-Exhaustion. — This is a condition of great depression of 
the system due to the action of heat, and, occurring in hot 
weather, it might be confounded with sunstroke or heatstroke. 
But in heat-exhaustion, instead of a hot, dry skin, there is a 
cold, moist one. This calls for rest, fresh air, and a cool apart- 
ment, but for no application of cold to the surface. Small 
doses of brandy or whiskey thoroughly diluted may be given, 
and the system gradually brought back from its depression. 

u Lightning -Stroke. — This is marked by evidences of shock, 
with reduction of the force of the circulation, weak pulse, and 
slow, sighing breathing. It is to be treated with rest and 
stimulants, and warmth applied to the body. 



"EFFECTS OF COLD. 

" Freezing is best treated by gradually bringing the tempera- 
ture up to that which is normal and maintaining it there. 
When ringers or toes are frozen or frosted, warm baths and 
gentle friction are to be used, afterwards covering with a 
thick, hot poultice. In such cases gangrene not infrequently 
follows the freezing. Frozen ears or noses are of less frequent 
occurrence, but must be treated on the same principles. 

" If the whole body has been exposed to extreme cold, there 
will follow a depression which requires the most cautious 
treatment. To restore its warmth is the first demand, and for 
this a warm bath, made gradually warmer until as hot as can 
be well borne, surrounding with heated blankets, or exposure 
before an open fire, may be used. 1 At the same time, stimu- 



1 " This recommendation is contrary to popular belief, and contrary to 
what is taught in most text-books, as well as in books on the treatment of 
emergencies. But it has been proved to be correct by experiments made 
in Eussia, where it was found that the best way to resuscitate dogs which 
had been frozen was to put them at once into a hot bath. Of twenty 



264 MOTHER AND CHILD. 

lants may be given internally, such as hot tea or coffee, with 
the addition of small quantities of spirits. 

" SPRAINS. 

" Sprains of the fingers or of the wrist require cold and moist 
applications. In the latter the hand and forearm should be 
covered with cotton, bandaged smoothly, and laid on a straight 
splint and lightly secured to it with a soft bandage or broad 
strips of sticking-plaster. One of these should go round the 
hand and one or two round the forearm above the wrist, — not 
over it. Sprains must be treated by rest, and by heat or cold, 
whichever gives the most comfort. 

" Sprains of the ankle are not infrequently complicated with 
a fracture of one of the malleoli [ankle-bones]. This compli- 
cation may give rise to much trouble, and requires very skilful 
and patient treatment. The general principle in the case of a 
sprained ankle is, first, to put the joint at complete rest, to 
allay inflammation if it arises, and afterwards to promote the 
absorption of inflammatory products. The foot and ankle 
should be covered with cotton or carded wool and a bandage 
carefully and smoothly applied. The use of a splint may 
usually be dispensed with, if the bandaging is well done. The 
dressings may remain undisturbed for days if the ankle is 
comfortable. If the dressings become loose from rapid dimi- 
nution of the swelling, they should be removed and reapplied. 
When this is done, careful massage or douching with alternate 
streams of hot and cold water may be useful. . . . 

" WOUNDS. 

" Wounds may be classified as contusions, contused, lacerated, 
punctured, poisoned, incised, and gunshot wounds. 

" Contusions are best treated at first, when painful, by the 

animals treated by the l gradual' method in a cold room, fourteen died ; 
of twenty introduced at once into a warm room, eight died ; of twenty- 
placed immediately in a hot bath, all recovered. 



SURGICAL EMERGENCIES. 265 

application of cold wet cloths. Pure laudanum is often a very 
acceptable application. Later, when the pain has subsided, 
hot wet cloths are best, as they favor the carrying off of the 
blood that has escaped. 

" In contusions of the chest or abdomen internal organs may 
be injured. Evidence of this may be seen in spitting of blood, 
or vomiting it, or passing it from the bowels or from the 
bladder; or there may be great depression. In such cases 
complete rest must be secured, and the strength of the sufferer 
sustained by means of warmth applied externally and careful 
stimulation internally, until the nature of the injury is exactly 
made out and a suitable line of treatment may be adopted. 

" Contused Wounds. — These are cuts or tears accompanied 
with bruising of the tissues. They are to be treated like lacer- 
ated wounds. Unless they bleed freely, warm applications are 
better suited to* such wounds than are cold ones. 

" Incised wounds, if simple and small, call only for a piece of 
adhesive plaster and perhaps a bandage. If large, the edges 
should be brought as near together as possible, and supported 
so by adhesive plaster or by bandages. If an entire part be 
cut off, as an ear, a nose, a toe, or a finger, it should be cleaned 
with lukewarm water, and put in its place, with sutures, band- 
ages, and a splint. Some very remarkable cases of reunion 
of such parts are on record, and an attempt to save them is 
not to be lightly rejected. 

" Lacerated Wounds. — In lacerated wounds the torn parts can 
be placed as nearly as possible in their natural position (after 
removal of any foreign matters that have entered them) and 
covered with cool wet lint, or with lint soaked in laudanum 
or in alcohol and water. If the tear has been very great and 
the sufferer is depressed and cold, teaspoonful doses of brandy 
or whiskey in hot water may be administered, and lint wrung 
out of hot water placed over the injured parts. 

" Punctured wounds are made with sharp-pointed objects, like 
arrows, pins, needles, tacks, fish-hooks, glass, thorns, splinters, 
or teeth. . . . 

m 23 



266 MOTHER AND CHILD. 

" Fish-hooks may be removed by a simple incision, or the 
string may be cut and the point of the hook pushed through 
the skin and the whole drawn out, as a needle would be in 
sewing. If it can be done, the broad part of the hook may be 
cut off before trying this. But this is usually not easy for 
the operator or the patient. 

" Splinters are dangerous in proportion to their size and 
according to the part they enter. Small splinters may be 
picked out with a needle. Splinters under the nails may be 
removed by scraping the nail as thin as possible over the splin- 
ter, then splitting it or cutting a little tongue out. 

"Splinters of glass must be removed by incision, and the 
wound treated on general principles. 

" Splinters in the eye should be removed with the greatest 
care, and, if possible, by a specialist. Afterwards the eyelid 
should be gently closed, both eyes covered with a layer of 
absorbent cotton soaked in cool water, and a bandage placed 
round the head, so as to keep the lids as still as possible. This 
bandage should not be too thick nor put on too tight, and the 
application should be kept cool, with ice, if need be. 

" Poisoned wounds are usually punctured, and result from the 
bites or stings of animals or insects. 

" The bites of venomous serpents usually demand the prompt 
removal of the part bitten. It may be cut out instantly. 
Before this the part should be encircled above the wound with 
a tight ligature, and, if small enough, thrust into the mouth 
and sucked hard, so as to extract the poison. Cauterization 
may be effected with anything at hand, like a knitting-needle 
or a nail, heated to redness. Stimulants may be administered 
if necessary. 

" The stings of tarantulas, scorpions, centipedes, etc., are to 
be treated with cold, and hartshorn applied to the point where 
the sting entered. 

" The stings of insects may be treated with cold, wet alkaline 
applications : wet earth is a very good one. The application 
of a drop of hartshorn or some wet salt often gives great relief. 



SURGICAL EMERGENCIES. 267 

" The bites of cats and rats are sometimes followed by severe 
inflammation. The treatment consists in cleansing the bites, 
and treating them as lacerated wounds. 

" The Bites of Dogs. — If any one be bitten by a dog in good 
health, only the simplest treatment will be necessary. If the 
dog be sick, local inflammation or severe constitutional dis- 
turbance may follow. In case of reasonable suspicion, the 
wound may be thoroughly cleansed and an application of 
hartshorn made to it, in addition to energetic sucking to extract 
any irritating material which may have entered it. A pro- 
longed study and considerable experience with regard to the 
subject have convinced me that the general practice of cau- 
terizing dog-bites with nitrate of silver is dangerous and should 
be abandoned. 

"Most medical men know that it is a foolish thing to kill a 
dog that has bitten anybody, soon after this has taken place. 
Such a dog should be caught and kept under the observation 
of a person of great carefulness, intelligence, and special infor- 
mation. The too speedy slaughter of a dog has robbed many 
a sufferer of the assurance that would have been gained by 
seeing it living and well, and has sent many a one to the 
grave, as dying of hydrophobia, who never had it, but had 
been bitten by a healthy and harmless animal. 



" SPECIAL HEMORRHAGES. 

" Bleeding from the nose, in children, is often nature's way 
of getting rid of an excess of blood ; but it may be so profuse 
as to threaten life. If this be the case, salt-and-water or 
vinegar may be snuffed up the nose, injected by a fountain- 
syringe, or applied by pouring with the head thrown back. A 
strong solution of alum in very warm water is also useful ; but 
vinegar is less disagreeable, and will seldom fail to check the 
bleeding. . . . 

" In hemorrhage from the lungs the blood is bright red and 
generally frothy. It is rarely profuse, and yet, as it is usually 



268 MOTHER AND CHILD. 

coughed up and caught in a handkerchief, it seems to be so. 
The amount can never be safely estimated in this way. The 
best treatment is rest in bed with the body raised in the sit- 
ting posture, and the swallowing of lumps of ice. The appli- 
cation of cold to the chest, if the patient is not too weak, is of 
some use, and a saltspoonful of salt and a teaspoonful of 
vinegar may be given every fifteen minutes. . . . 

" In hemorrhage from the stomach the blood is usually very 
dark, looking like coffee-grounds. If it is mixed with any 
other contents of the stomach, its appearance may be masked. 
In such cases ice-water or broken ice may be swallowed, and 
teaspoonful doses of vinegar. Best in bed must, and the 
application of cold to the stomach may, be employed, with 
tannic acid in five-grain doses. 

" Hemorrhage from the bowels may be treated with ice-water 
injections and the application of ice to the abdomen. ... 

" In severe hemorrhage, rest in bed, without a pillow, and 
with the head lower than the body, must also be secured. 



" POISONS. 

" As it is better to prevent accidents than to correct them, it 
is a good plan to have dangerous articles kept invariably out 
of reach of children, and to have any bottle containing what 
may be dangerous marked by a ball and chain, such as the 
druggists sell, or by tying a stout piece of tape round its neck. 
This gives warning in the dark as well as in the light. 

"When there is reason to believe that a child has taken a 
poison of some sort, it may be known what has been taken, or 
it may not be known. We will consider first 

" Unknown Poisons. — If the child should vomit, this should be 
encouraged ; if not, it must be provoked. The simplest way 
to do this is to give large draughts of lukewarm water, and 
to titillate the fauces. If there is time, and it is at hand, a 
teaspoonful or two of ground mustard may be stirred up in 
the water, or a teaspoonful of powdered ipecac, or a tablespoon- 



SURGICAL EMERGENCIES. 269 

ful of the syrup of ipecac. There is no occasion for fastidious- 
ness. Any water will do. Water in which hands — or dishes, 
for that matter — have been washed may by its very repulsive- 
ness act more quickly than anything else j and if soap has 
been used, it will be all the better for that, as soap is an anti- 
dote for acid poisons. The quantity used must be large ; the 
sufferer must be urged to drink and drink, a large quantity at 
a time, until he can contain no more, and has been made to 
vomit over and over again. 

"After copious vomiting, soothing liquids should be given, — 
oil, milk, beaten-up raw eggs, — all in moderately large quanti- 
ties. These are especially valuable when the poison has been 
of an irritating character. 

" If the sufferer be much depressed, some stimulant may be 
administered. Strong, hot tea, without milk, is the best, 
because it is a chemical antidote to many poisons. Strong 
coffee is next in value. To either of these can be added 
brandy, whiskey, wine, or alcohol, in half-teaspoonful doses, 
mixed with a little hot water. Warm coverings are not to be 
forgotten ; and if the depression be great, hot-water cans or 
hot bricks, wrapped in one or two thicknesses of blanket, 
should be laid by the side of the chest, or a large poultice 
placed round the body, or a blanket wrung out of hot water 
and covered with a dry one. 

" Mineral Acids. — For these the proper treatment is to give 
an alkali. A tablespoonful of hartshorn may be mixed with 
two teacupfuls of water and given ; or almost unlimited quan- 
tities of soda, magnesia, potash, whitewash, chalk, tooth- 
powder, whiting, plaster, soap, or even wood-ashes, stirred up 
in water. After this should come the provoking of vomiting ; 
then the bland fluids mentioned above should be administered, 
rest secured, and stimulation employed if necessary. 

" Oxalic Acid. — For this the best antidote is lime in some 
form. If lime-water is at hand, it may be given freely, or 
whitewash, tooth-powder, chalk, whiting, or plaster from a 
wall. The latter may be crushed and stirred up in water, 

23* 



270 MOTHER AND CHILD. 

without regard to the grittiness, which will not do any 
harm. 

" Carbolic acid is a very dangerous poison, because it acts 
rapidly and benumbs the stomach, so that it is hard to pro- 
voke vomiting. This must be attempted, however, and large 
draughts of oil, white of egg, magnesia and water, or milk 
must be given. Best, warmth of the body, and stimulation 
must also be secured. 

" Alkaline Poisons. — Strong alkalies must be combated with an 
acid. Yinegar can always be had, and there is nothing better. 
It should be given undiluted and in large quantities. Lemon - 
juice may be used, or even orange-juice, though the latter is 
too mild an acid to be of much service, unless the oranges are 
very sour. Vomiting should then be provoked, and followed 
by bland drinks, rest, and stimulation if necessary. 

"Arsenic usually excites vomiting and violent pain in the 
stomach. At once large quantities of milk, white of egg, 
flour-and-water, or oil and lime-water must be given. The 
vomiting must be encouraged or provoked, and dialyzed iron 
should be given freely, in tablespoonful doses, each dose being 
followed at once by a teaspoon ful of common salt in a teacup- 
ful of water ; or, if this is not at hand, equal parts of sulphate 
of iron and of carbonate of sodium may be dissolved in 
separate cups of hot water and then mixed and drunk. After- 
wards vomiting should be again provoked, and followed by a 
dose of castor oil. 

" Acetate of lead calls for vomiting, Epsom salt, milk, and cas- 
tor oil. 

" Corrosive Sublimate. — When this is taken vomiting must be 
provoked, and some form of tannic acid given. Strong tea is 
the handiest thing containing this, and its administration should 
be followed up with eggs and milk. 

" Tartar emetic is best treated in the same way. 

" Phosphorus is sometimes chewed off matches by children. 
It is a poison which acts slowly. Five-grain doses of sulphate 
of copper dissolved in water may be given, at intervals of ten 



SURGICAL EMERGENCIES. 271 

minutes, until vomiting comes on. Then a dose of magnesia 
should be administered, but no oil. 

" Nitrate of Silver. — The antidote for lunar caustic is a very 
strong brine of salt-and-water, given again and again ; and 
vomiting should be provoked until the vomited matters cease 
to have a look like thin milk. 

"Iodine, in the form of a tincture, is also sometimes swal- 
lowed by mistake. The antidote for this is starch-and-water. 

" Opium preparations, such as opium, morphine, laudanum, 
paregoric, black drop, must be combated with emetics, used 
promptly. Strong coffee must be freely given as a stimulant. 
So long as the breathing does not fall below ten to the minute, 
there is no immediate danger of death ; but the important mat- 
ter is to keep up the breathing. The custom of walking a 
patient up and down and slapping him with wet towels is to 
be deprecated, because it adds exhaustion to stupor. If an 
electrical battery can be obtained, the faradic current should 
be used, and applied so as to stimulate the sensory nerves in 
the skin, so that they shall excite reflex acts of deep breathing. 
The next best thing is to lay the patient upon a lounge and 
slap his skin with the back of a broad brush or with a slipper. 
This is all the rousing that is necessary, so long as the breath- 
ing keeps above ten to the minute. Should it fall below this, 
or if the breathing should cease, artificial respiration should 
be employed. 

" Chloral. — The treatment for chloral poisoning is the same 
as for poisoning by opium. 

" Strychnine poisoning should be treated by provoking vomit- 
ing, giving a purge, and doses of fifteen grains of bromide of 
potassium or ten grains of chloral, or both. The greatest quiet 
must be secured. The poisoned person should be put to bed in 
a darkened room, with doors, windows, and shutters arranged 
in a way that shall exclude all sights, sounds, and draughts, 
though permitting good ventilation. 

" Aconite. — In case of aconite poisoning vomiting must be 
brought on, and followed by the administration of stimulants. 



272 MOTHER AND CHILD. 

Strong coffee may be used, hartshorn (a teaspoonful in a 
teacup ful of water), wine, whiskey, or brandy. If there is 
depression, warmth should be used, as described when speaking 
of unknown poisons. 

" Veratrum viride poisoning is to be treated like aconite poi- 
soning. 

" Hemlock, deadly nightshade, the Jamestown (or jimson) weed, 
monkshood, and toadstools are sometimes eaten, without knowl- 
edge of their poisonous character. Tobacco, too, sometimes 
causes poisonous effects. All produce deep depression, and 
must be treated by the induction of vomiting, if it has not 
already occurred, followed by stimulation and warmth, very 
much as in the case of aconite poisoning. 

" Alcoholic liquors are sometimes taken in such large quanti- 
ties as to be poisonous. When this is the case the course to 
be pursued is to cause vomiting, give hartshorn-and-water (a 
teaspoonful in a teacup ful), and keep the body warm. 

" Decayed meats or vegetables usually excite vomiting, which 
should be encouraged till the stomach is empty, and followed 
by a dose of castor oil and some powdered charcoal. 

" In conclusion, let it be remembered that when there is an 
alarm of poisoning it is important to keep cool. In many cases 
of poisoning there is much more alarm than danger. Death 
from accidental poisoning is very rare. To save time in an 
emergency, the following table may be consulted, which gives 
the name of each of the poisons we have already studied, and 
the proper treatment for it. 

" Poison. Treatment. 

Provoke repeated vomiting ; 
Unknown -j Give bland liquids ; 



Acids , 



,1 



{ 



Sul P huric ' j I Provoke vomiting; 

Nltnc ' J- J Give bland liquids ; 

Muriatic > ! S^nrP.Wr 



Stimulate, if necessary. 
Give an alkali 



0xahc ' I Stimulate, if necessary. 

Carbolic, J L ' J 



SURGICAL EMERGENCIES. 



273 



"Poison. 
Alkalies : 

Hartshorn, i 
Soda, j- . . 

Potash, 
Lye, J 

Arsenic : 
Paris green, 
Scheele's green, 



Acetate of Lead : •> 
Sugar of Lead, j 



Corrosive Sublimate, -» 
Tartar Emetic, j 



Phosphorus 



Nitrate of Silver 



r 



Treatment. 
Give an acid (vinegar) ; 
Provoke vomiting ; 
Give hland liquids ; 
Secure rest ; 
Stimulate, if necessary. 
Provoke vomiting ; -\ repeat sev- 

Give dialyzed iron and salt ; J era! times ; 
Give dose of castor oil ; 
Secure rest; 
Stimulate, if necessary. 
Give Epsom salt ; | repeat seyeral timeg 
Provoke vomiting ; i 
Give bland liquids ; 
Give dose of castor oil. 



} repeat 
several 
times : 



Iodine 



Opium : 
Morphine, 
Laudanum, 
Paregoric, etc. 

Chloral, 



Strychnine 



Aconite, -\ 

Veratrum Viride, j 



Provoke vomiting ; 

Give strong tea, without milk ; 

Give raw eggs and milk ; 

Give dose of castor oil ; 

Stimulate, if necessary. 

Provoke vomiting ; 

Give five-grain doses of sulphate of copper, 

or teaspoonful doses of turpentine ; 
Give dose of magnesia, but no oil. 
Give strong salt-and- water ; \ repeat many 
Provoke vomiting ; J times. 

Provoke vomiting ; 
Give starch-and- water ; 
Give bland fluids. 

Provoke vomiting repeatedly ; 
Give strong coffee, without milk ; 
Keep up the breathing. 

Provoke vomiting once or twice ; 
Give a purgative ; 
Secure absolute quiet. 
Provoke vomiting ; 
Stimulate well ; 
Keep head low. 



f Provoke vomiting ; 
I Stimulate well. 



274 MOTHER AND CHILD. 

" Poison. Treatment. 

Jamestown Weed, 

Hemlock , 

Nightshade (belladonna) , 

Toadstools, 

Tobacco, 

Alcohol j Provoke vomiting ; 

I G-ive hartshorn-and-water. 

{Provoke vomiting ; 
Give a purgative ; 
Give powdered charcoal. 

u t jp rovo ] ie vomiting, warm water may be used, with or 
without ground mustard (a teaspoonful to half a pint of 
water), or ipecacuanha (a teaspoonful of the powder or a 
tablespoonful or so of the syrup), and titillating the fauces. It 
is best to give large quantities (half a pint at a time) of warm 
water whenever vomiting is to be excited. 

" Bland liquids are milk, raw eggs, some sort of oil, gruel, etc. 

" Stimulants are tea, coffee, whiskey, wine, etc., or hartshorn- 
and-water. A teaspoonful of hartshorn in a teacupful of 
water will be enough for a dose. In making tea or coffee one 
must not wait to do it as if for the table, but mix hot water 
and the leaves or grounds, squeeze them well, stir together, 
and give the whole, — leaves, grounds, everything. At the 
same time, some may be made regularly, if there are con- 
veniences for it. 

" Alkaline antidotes are hartshorn-and-water (a tablespoonful 
in two teacupfuls of water), soap-and-water, lime, whiting 
soda, chalk, tooth-powder, plaster, magnesia, whitewash, and 
even wood-ashes. 

" Acid antidotes are vinegar and lemon-juice. 

" In giving an antidote, never wait for it to dissolve. Just 
stir it up in any fluid at hand, except oil, and have it swallowed 
immediately." 



FRESH AIR, VENTILATION, OUT-DOOR EXERCISE. 275 



CH-APTEE XXXYIII. 

FRESH AIR, VENTILATION, OUT-DOOR EXERCISE. 

There is no more important subject for us to study than 
that of ventilation, by which we mean the getting rid of foul 
air and the entrance of pure air in as easy a manner as pos- 
sible, free from draughts. We all know that cold air passing 
through a chink, and then striking against some sensitive 
nerve-point on the surface of the body, has a peculiar faculty 
of abstracting heat, or giving what is known as ' ; a cold," 
affecting the mucous membranes. Of course, the more deli- 
cate or the younger the individual the more susceptible he 
will be to such an impression. There are certain parts of the 
body very susceptible to these currents of cold air ; these are 
the face, neck, and feet; neuralgia, sore throats, and colds in 
the head being the consequence. But it is to be observed 
that these draughts are more apt to make themselves felt 
when the parts on which they strike are in a state of relaxa- 
tion ; naturally, should there be perspiration, its evaporation 
would intensify the cold impression. "When children, then, 
after active play, and perspiring freely, sit in a room in a 
draught, they will take cold, while, on the other hand, they 
might continue their play in a colder room and not feel it; 
the action of their muscles, the excitement, giving them an 
immunity which they would not have in a state of quiescence. 
It should be our object, then, in the choice of a nursery, to 
have a room, or two rooms communicating (when speaking 
of these matters we specially refer to city houses), as far 
removed as possible from the contaminations and filth of 
the streets. The play-room should be large, should be situ- 
ated in the second or third story, and should have the sun- 
shine in it at least part of the day. A child's room should 



276 MOTHER AND CHILD. 

have no communication whatever with a bath-room, water- 
closet, or stationary wash-stands. Children are peculiarly sus- 
ceptible to the effects of sewer-gas, or sewer-air contaminated 
with germs, and many a case of diphtheria, or so-called mem- 
branous croup, has succumbed to the subtle influence of the 
poison of the disease which has most insidiously been con- 
veyed to the air of the room through traps that the plumber 
has pronounced absolutely safe. We have witnessed such 
distressing scenes in the houses — one might say palaces — of 
the wealthy, have seen such frightful cases of malignant diph- 
theria where money was no object in making the house perfect 
in all respects, but where, unfortunately, ignorance or avarice 
on the plumber's part allowed a deadly leakage of non-odorless 
sewer-air to go directly to a babe's room, that we feel we 
cannot say too much by way of caution. 

Of course, for a few weeks the new-born babe will sleep 
with its mother; if it is a strong and vigorous child it may be 
put in a crib or bassinet by her side. The great objection 
to placing the child away from the mother is that, after the 
nurse leaves, she will have to reach for it, and if her room is 
cooler at night, as it should always be, there will be great 
danger of her taking cold when she nurses the baby. On this 
account, the child's crib should be placed as near as possible to 
the mother's bed, or she should allow it to sleep in the bed 
with her, but so placed that it will have a portion of the bed 
entirely to itself. The child is, certainly, after a couple of 
months, healthier when sleeping alone. 

For the first month, at least, after birth, while the nurse is 
still with the mother, she should take charge of the infant and 
bring it in to nurse at the proper hour. The choice of a nur- 
sery and sleeping-apartment is a matter of great importance. 
The essentials are purity of atmosphere, uniformity of tem- 
perature, and freedom from dust and gases which may arise 
from methods of heating ; especially is this the case with 
faulty hot-air furnaces. There should be plenty of sunshine 
when possible. At the present day. with our extended knowl- 



FRESH AIR, VENTILATION, OUT-DOOR EXERCISE. 277 

edge of the causes of disease, impurity in the atmosphere has 
assumed great importance ; we are now able to recognize the 
fact that certain diseases which were hitherto attributed to 
cold, are in reality due to filth ; that certain other intestinal 
disturbances which were attributed to heat, are in reality due 
to decomposed or fermented food and to bad milk, These 
facts are most important to bear in mind, not only to enable 
us to cure disease, but also because, by a thorough recognition 
of them, diseases or disorders which have been attributed 
to climacteric disturbances, may, by the timely institution of 
hygienic measures, be avoided. There is no reason why a 
child that has a well-ventilated, clean, bright nursery, whose 
milk is watched with zealous care and never allowed to become 
tainted, one who is daily bathed, not overfed, neither debili- 
tated by too heavy clothing nor subjected to daily fluctuations 
in bodily temperature, should not pass through the summer 
season in a city unharmed by the so much dreaded summer 
weather. We mention this because, probably, many mothers 
who read this book cannot afford to spend the summers out 
of town. 

A nursery should always have an open fireplace for ventila- 
tion, and a counter-opening should be made over the window, 
so as to allow the air to be changed with the least draught 
possible ; this can be done by pulling down the top sash and 
inserting a four-inch strip of board to keep it down ; by this 
means an indirect current will be made between the sashes. 
Of all the methods of heating, probably the most used, but, 
unfortunately, the one that can be most abused, is the hot-air 
furnace. Parents should see that their nurseries are supplied 
with air that is, first of all, pure : it must be taken at as great 
a distance as possible from the ground, and not immediately 
off gutters and damp yards, as is very frequently the case. 
The air most charged with atmospheric impurities, whether 
they be germs or gases, is that which is usually heated and 
sent to the nursery ; the heating simply making it more poi- 
sonous than before. The heated air should be passed over a 

24 



278 MOTHER AND CHILD. 

surface of pure water, by which means it will receive a cer- 
tain amount of moisture, and should then be carried, as free 
from dust as possible, directly to the nursery. Air which is 
not passed over water, but simply dried, will undoubtedly pro- 
duce various forms of irritation of the mucous membranes, 
dryness of the throat and nose, languor, — symptoms which 
we all recognize at once. Certainly nothing can be better 
than an open grate, with a wood fire, even if it be only oc- 
casionally used, to supplement the furnace, especially at 
night ; but we much prefer a system of hot water and indi- 
rect radiation for the heating of houses in our changeable 
climate. 

We have always insisted that either an earthen water-vessel 
which comes for the purpose be filled with water and placed 
in front of the "register" in the nursery, or else a basin of 
water with a towel dipped into it, the upper corner of the towel 
being pinned above the register. In a sick-room the water can 
be medicated, if necessary. 

The sleeping-room should be heated through the nursery, 
if possible, and should be occupied only at night. Of course, 
these matters are difficult to control, but at the same time, 
if parents know what ought to be done and take an interest in 
the matter, — think for themselves, — many arrangements can 
be made to overcome temporary difficulties which at first seem 
insurmountable, and thus render a dreary, unhealthy nursery 
healthful and habitable. The nursery should always have a 
thermometer, and the temperature should be kept at about 
68° or 70° F. The heat should be always shut off at night, and 
the bedclothing so arranged as to prevent its being thrown off 
while the child is perspiring during the early morning hours, 
when the system is most depressed, and at which time the 
danger of catching cold is most imminent. For an infant, the 
sleejnng-room should be kept as much as possible at the same 
temperature day and night. Avoid all sewerage arrangements 
— pipes of every kind — in a nursery. The science of ventila- 
tion and house-drainage gives us probably as perfect a system 



FRESH AIR, VENTILATION, OUT-DOOR EXERCISE. 279 

as we shall ever have, but, unfortunately, the slightest fault 
of construction will turn the otherwise harmless contrivance 
for our comfort into one of the most deadly ; and there is no 
means by which we can detect the presence of the sewer-air 
that serves as a carrier of the poison of diphtheria or typhoid 
fever, any more than there is evidence of the existence of their 
germs in drinking-water. The most costly habitations of 
the wealthy have these dreaded diseases carried into their 
midst to a greater extent even than is found among the poor. 
The classes of persons who suffer most from diphtheria are the 
very wealthy and the very poor. Those of moderate wealth 
guard their children carefully against cold, in the first place, 
and their limited means prevent them from having those lux- 
uries by means of which the deadly sewer-air is carried into 
their bedrooms. Physicians believe that diphtheria most fre- 
quently requires a cold, a catarrh in the throat, before the 
poison is thoroughly absorbed, and probably this accounts for 
the resistance which is observed in so many cases to an attack 
in the summer. Just as soon as the child takes cold, becomes 
a little run down, that dreaded disease will show itself. 

The drinking-water should be pure ; when there is the 
least doubt about its purity it should be boiled. We think 
every household would be safer in having a Pasteur filter. " A 
stitch in time saves nine;" a little expense and trouble may 
save a loved one from death by typhoid or diphtheria. It 
should also be remembered that ice is a great carrier of dis- 
eased germs ; in fact, that the freezing process merely benumbs 
them to render them as virulent as ever when thawed. If 
possible, only artificially-made ice should be used, and if it cam 
not be obtained, the strictest care should be taken that natural 
ice, from however pure a source, should not come in contact 
with the infant's food. With the Pasteur filter comes a " cooler" 
by which the water can be cooled. Iced water is not healthy 
for children ; water should be cool, not cold. 

We have laid great stress on the importance of thorough 
ventilation and fresh air, but we wish it distinctly under- 



280 MOTHER AND CHILD. 

stood that constancy in the purity of air, both day and night, 
is not only requisite in the nursery, but also in the sick-room. 
Cold air is not necessarily pure air, nor is air which is warmed 
made impure by warming ; at the same time it should be 
remembered that air filled with germs of disease, warmed by 
a "heater," may become most deadly when carried to the 
sleeping-chamber. A child's vitality is lowered at. night, its 
circulation is slower, its resistance to disease is less. A person 
sleeping and chilled is much more liable to take cold than one 
who is awake ; especially is this so in childhood and old age ; 
but the temperature of the sleeping-room may be reduced 
at night (the heat being turned off), with benefit, if the child 
is covered — not enough to induce perspiration — and the cloth- 
ing so arranged as not to be thrown off. Of course, a child, 
up to at least six months, should be kept in a room which has 
as nearly as possible the same temperature day and night, as 
it sleeps most of the time, and when taken out of doors is so 
warmly clad that the change of air cannot affect it. 

To sum up, then, a nursery, or child's living-room and bed- 
room, should be kept scrupulously clean, thoroughly aired, 
and should be free from dust ; dust, independently of its irri- 
tating character upon the mucous membrane, is the means of 
conveying disease. The room should be swept with a patent 
sweeper, and the dust which has accumulated should be care- 
fully wiped off the places of its lodgement by means of a damp 
cloth. The ideal nursery floor is one of hard wood, well laid 
and polished, with rounded corners, and covered with a rug, 
which should be shaken frequently. There are many days in 
our treacherous climate when a child cannot be taken out of 
doors ; indeed, there are many days when it had better remain 
in its well-aired nursery, — days during which, if it went out of 
doors in its perambulator, it would inhale the exhalations from 
the foul masses that accumulate in our city streets. A child 
in arms is far safer when carried out of doors for fresh air than 
is one in a perambulator upon its first going out. 

The day nursery should be supplied with plants. They are 



FRESH AIR, VENTILATION, OUT-DOOR EXERCISE. 281 

undoubtedly beneficial to health when properly cared for, and 
make the living-room bright and cheerful, and this reacts on 
the disposition of the child. A bright, happy home makes a 
bright, happy child, and what is freqently taken for temper, 
perverseness, in many children is often sickness and unhappi- 
ness. Happiness tends to health, and health is greatly depend- 
ent on happiness. A child, from its infancy, that can take a 
"no" from its parents as an ultimatum is far happier than 
one who constantly frets for the purpose of having its whims 
gratified. The parent who forbids the child five times and 
then relents establishes a precedent that will invariably give 
rise to trouble in the future. A command should always be 
observed, a "no" should always be a "no," and such a bring- 
ing up will help the doctor in case of illness— save life, perhaps 
— and make the child a blessing in the house and a delight to 
all who come in contact with it. An unhappy time indeed 
has the doctor who is called to attend a child in illness who 
has been accustomed to say, "I won't" or "I will." Those 
who are much thrown among children recognize this fact ; in- 
deed, it is one which every grown person feels when he or she 
looks back to childhood days. The energy and buoyancy which 
comes with good health is in marked contrast to the depression 
and irritability that is associated with illness, or, if not ex- 
actly illness, with those sedentary pursuits that are in them- 
selves unhealthful. 

In an excellent article on "Xursery Hygiene," 1 Dr. L. M. 
Yale says, — 

" In selecting a room for a nursery, that should be chosen 
which is the sunniest, best aired, and driest; and in deciding 
between two or more houses in other respects equally eligible, 
distinct preference should be given to that one admitting of 
the best arrangements for nursery purposes. In houses where 
no room is to be specifically set apart as a nursery, and chil- 
dren are to occupy the general living-room by day and the 

1 Keating's Cyclopaedia of the Diseases of Children, vol. i. 
24* 



282 MOTHER AND CHILD. 

parents' bedroom by night, the same rules should govern the 
selection of these rooms, the sanitary benefit in such case 
accruing to adults and children alike. When the nursery is 
separate it is preferably to be placed above the ground-floor, 
unless the latter be unusually well raised from the ground, 
but it should not be immediately under a roof, on account of 
the difficulty of regulating the temperature in such a situa- 
tion. 

" The beneficial influence of sunlight needs no insisting upon ; 
nevertheless it is constantly overlooked. The nursery should, 
if possible, look to the south, or as nearly so as the situation 
of the house permits, with a morning exposure in preference 
to an afternoon sun, if but one can be had. The windows 
should be ample in size, and more than one if possible, as they 
not only serve for the admission of light, but in the ordinary 
dwelling are the only avenues of ventilation. The sensibility 
to the loss of sunlight seems to vary somewhat with adult in- 
dividuals, but we believe that all children suffer from its ab- 
sence ; and the physician should insist upon the daily complete 
sunning of the apartment. In summer, even, it is usually 
better to have the sun and to mitigate its power at proper 
times by means of awnings and blinds than to have a room 
upon which it does not shine. There may be circumstances 
of climate or of prevailing winds which will modify this rule, 
but it holds in general. The room should be of ample size, 
particularly if it serve, as is the rule in ordinary houses, the 
double purpose of night and day nursery. The precise amount 
of space required for each child will vary with the arrange- 
ments for ventilation, but not less than fifteen hundred cubic 
feet of air per hour should be allowed, and preferably double 
that amount. 

" As only in the houses of the wealthy can a room be specially 
set apart as a sick-bay or hospital, the nursery must ordinarily 
serve that purpose whenever illness occurs. For this reason, 
as well as for others, the furnishing of a nursery should be as 
simple and as easy of cleansing as is consistent with comfort. 



FRESH AIR. VENTILATION, OUT-DOOR EXERCISE. 283 

The floor should be of smooth, closely -joined boards, preferably 
of hard, close-grained wood. The seams, if they open by 
shrinkage, should be closed either by relaying or by calking 
well done. Poor calking is worse than useless, and any calk- 
ing is inconvenient in rooms the floors of which must be raised 
to reach gas- or water-pipes, as is unfortunately often the case. 
Carpets are necessary to comfort, but movable carpets or rugs 
are far preferable, as permitting more frequent cleansing both 
of the carpet and floor. At the present time even cheap grades 
of carpets are made in rug form, or the desired pattern can be 
made up with tasty borders without much expense. In case 
of actual illness of a contagious nature the rugs may be taken 
away at once, and their contamination be prevented, which in 
view of the difficulty of subsequent disinfection is very desira- 
ble. The same precaution against dangerous dirt leads to the 
preferring of painted and varnished to papered walls for the 
nursery, even at the loss of some beauty in the apartment. 
If paper is strongly insisted on, it should be of a kind that can 
be thoroughly varnished and will admit of being washed, and 
ail old paper must be first removed before new is laid. The 
furniture of the room should be as lio*ht as consistent with 
serviceability, in order that the pieces may be easily moved 
from place to place to admit of frequent cleansing ; and for 
the same reason, every bulky or heavy article should have 
large and strong casters. It is further desirable that all furni- 
ture should be as plain and simple as possible, carved wood and 
thick upholstery stuffs being objectionable as receptacles for 
dust. Taste may be gratified without violating this require- 
ment. Further, all cupboards, closets, and similar places of 
deposit should be as open to inspection as possible, in order 
that offensive or untidy things may easily be detected and re- 
moved. On account of this facility of examination and cleans- 
ing, the writer usually prefers shelves with a removable curtain 
in front to closed cupboards and deep drawers. The latter are 
suitable enough for clean linen, but are temptations to careless 
attendants to indulge in ' tuck-away neatness.' 



284 MOTHER AND CHILD. 

" Warming and ventilation can only be touched upon in this 
article. If the nursery is in a house with a good system of 
heating and ventilating, nothing in particular will be needed 
except a grate or a stove for use in emergencies. Ordinarily, 
however, even houses which have a fairly good furnace or 
other heating-apparatus have no specific arrangements for 
ventilation beyond what are afforded by the windows, chim- 
neys, and imperfections of structure. The ordinary methods 
of warming in use in this country are open fires, stoves, and 
hot-air furnaces. The hot-air furnace, if properly constructed, 
is quite satisfactory. Its commonest faults are the delivery 
of too small a quantity of air at too high a temperature (a 
larger quantity at a lower temperature being preferable), and 
such an arrangement of its cold-air flue that the supply is 
from an impure source. The former difficulty is overcome by 
having the furnace considerably larger than necessary and by 
kteeping the fire moderate ; the latter, by using a tight metal 
flue the outer end of which is free from unwholesome surround- 
ing and preferably raised some feet from the ground, by which 
means some of the foul air of dark city back-yards or of the 
gutters is avoided. The same precaution is of use in many 
country houses. The outer end must be protected by a wire 
screen, to prevent mischief being done by children or small 
animals. It the screen be fine-textured it will diminish the 
amount of dust drawn into the house. For a nursery it is of 
advantage to have the registers for warm air rather high, as 
this arrangement makes a better general circulation of air, 
diminishes the intensity of floor-draughts, and renders med- 
dling with the register by small children more difficult. 

" The open fireplace has for advantages cheerfulness of aspect 
and a fair amount of ventilating -power, for disadvantages 
great wastefulness of fuel in proportion to its heating-power, 
so that ordinarily, when this is the only source of heat, great 
differences of temperature exist in different parts of the room ; 
if the neighborhood of the fire is comfortable, the remoter 
parts are cold. Further, it ventilates by the production of 



FRESH AIR, VENTILATION, OUT-DOOR EXERCISE. 285 

draughts, particularly of floor-draughts, which are especially 
dangerous in the nursery, where little children spend so much 
of their time upon the floor. The wood fire is very beautiful 
and useful when a short, quick heat is needed, but, aside from 
its costliness, it is not so good for steady heating as a coal fire. 
In the nursery any open fire must be carefully guarded by a 
strong wire screen, to prevent accidents from sparks or from 
the clothing of children taking fire. Stoves of the ordinary 
close varieties, the ' air-tights,' are very economical of fuel, 
but nearly useless as ventilators, and if used make especial 
watchfulness as to ventilation necessary. The ventilating 
stoves which are the offspring of the old ' Franklin' make a 
compromise by which all the ventilating value of the open 
grate is preserved with far less waste of fuel, about three 
times as much of the heat-value of a given amount of fuel 
being utilized by these stoves as by the open fire. The prin- 
ciple of construction in its simplicity is to surround the stove 
and its smoke-flue for some distance with an air-chamber ; to 
this chamber air is admitted, preferably from out of doors, 
and as it is warmed it is poured into the room at a higher 
point, — for instance, near the mantel. As regards all stoves, 
it is perhaps safer to have no damper in the smoke-flue, or else 
to fasten it so that it cannot be closed without difficulty, since 
by so doing the danger of the gases of combustion being 
forced into the room is removed. 

" Ventilation, in a house which has been constructed with no 
reference to it, usually must be accomplished by simple devices 
or not at all; any radical improvements would be practical 
reconstruction. The most natural thing to do to let in . fresh 
air and let out foul is to open a window ; but this of course in 
cold weather involves dangerous draughts. We cannot, with 
our fickle and often severe climate, even do as some English 
writers suggest should be done, — fasten the upper sash so that 
it cannot be quite closed. Window-ventilation, therefore, must 
in winter be carried on by means of some contrivance which 
will break the force of the current of air and direct it upward 



286 



MOTHER AND CHILD. 



so that it may be diffused about the room. The 'elbow-tube' 
ventilator placed under the lower sash is well known ; so are 
various wire screens, either vertical or ro- 
Fig. 34 fating like at ransom. A very useful one, and 

the simplest and cheapest, is the common 
window-board, which, fitting against the in- 
side of the lower sash, allows the latter to be 
raised and the current of air inward is sent 
directly upward at the overlapping of the two 
sashes. The board should be at least eight 
inches high. The plan of a stout cloth nailed 
across the lower part of the window allows, 
when the sash is raised, two currents, one 
above and one below. The writer thinks he 
gets the same advantages by modifying the 
window-board as in the figure. The strip B 
runs the whole length of the board. If it is 
desired to shut off the lower current, the sash 
is left in contact with the strip ; if the lower 
current is desired, it is left below the strip, 
as at A. 

"The stove with jacket used in barracks 
seems to be well adapted for nursery use. 
The stove is surrounded by a jacket of sheet 
zinc or iron, with necessary doors, leaving 
space between the stove and the jacket. This 
should come to the floor, and the cold air be 
brought from out of doors to within the 
"svC^ jacket by means of a small pipe ; the air es- 

capes warmed at the top of the jacket. For 
the nursery the jacket has the advantage of being a safeguard 
against burns, at least against severe ones. 

" The getting of foul air out is a rather more difficult problem, 
especially with stove heat. An open window with the double 
current described will do fairly well under favorable circum- 
stances, but is rarely sufficient when an air-tight stove is used. 



FRESH AIR, VENTILATION, OUT-DOOR EXERCISE. 287 

If in the construction of chimneys a ventilating-flue is in- 
cluded, or if the smoke-flue is enclosed in a space which may 
serve as a ventilation-flue (as, for instance, a stove-pipe run- 
ning up within a chimney which has a fireplace at the bottom), 
it is easy to ventilate a room. If the chimneys are already 
closed in, the cheapest and at the same time an efficient 
method is to have an air-flue leading from near the floor into 
the chimney higher up. The upward current of air in the 
latter draws the air through the ventilating-shaft. It is more 
efficient if placed near the stove, so that the air within it is 
heated and its upward movement hastened. Its mouth is 
placed low, to save unnecessary waste of warm air. 

" It should be remembered that the artificial light of lamps 
or gas in a room rapidly spoils air for breathing. Lighting- 
capacity is usually measured in candles, and an average adult 
produces rather less than twice as much carbonic acid as one 
candle: as a consequence, a large kerosene lamp or gas-burner 
often equals the production of five or six adults. It is very 
desirable, therefore, if a night-light is necessary in the nursery, 
that its carbonic acid be got rid of; and by the device, often 
used for ventilating purposes, of putting the burner or lamp 
within or beneath a tube or flue going to the roof or chimney, 
the results of combustion are carried away and an outward 
current of small power is also established. By having at the 
bottom of the flue a box, with a door, to contain the light, the 
latter may be shut off partly or wholly except when needed. 

" As to the temperature of the nursery authorities are not 
quite agreed ; but it is certain that in American cities it is usu- 
ally too high, in common with that of the rest of the house. 
Children and adults are often forced to endure in winter apparel 
a temperature (70° F. and upward) which in summer is con- 
sidered to demand much lighter dress. There are good reasons 
why the standard of house-temperature is usually set high in 
America, but it is carried too far, The discrepancy between 
in-door and out-door temperature is made too great, the skin 
and mucous membranes are made sensitive, and the multitudi- 



288 MOTHER AND CHILD. 

nous forms of ' colds' favored. We believe that if a room 
can be uniformly heated, 65° F. will be found, on the whole, 
more comfortable and healthful than the usual 70° F., which 
latter should not be exceeded. "Where intelligent supervision 
of the temperature can be relied upon, we believe that a still 
lower degree than 65° F. will be healthful to children old 
enough to play about. At night the temperature should not 
be allowed to fall too far below the day standard ; and especial 
pains should be taken to guard against the uncovering of 
children in bed. 

" A word should be added concerning windows. As is well 
known, the loss of heat from the cold glass is very great : Mr. 
Hood puts it that by each square foot of glass more than ono 
and one-quarter cubic feet of air (1.279 cu. ft.) will be lowered 
each minute as many degrees as the difference between the 
internal and external temperatures. If, for instance, the ther- 
mometer outside showed no colder than freezing temperature, 
32° F., and within no higher than 67° F., the discrepancy 
would be still 35° F. A window three feet by six feet would 
expose eighteen feet of glass surface, and according to this 
rule it would cool each minute (18 X 35 X 1-279 ±=) 805 + 
cubic feet one degree, or about two hundred cubic feet four 
degrees. This makes a constant current of descending cold 
air near a window very sensibly felt by any one obliged to 
work in such a place in cold weather. It is important, then, 
that children should not play immediately near a window in 
cold weather, and a low article of furniture may be often so 
placed as to keep them away without the trouble of constant 
oversight. The ingenuity of the attendant will similarly 
devise means of keeping them from sitting on the floor if it 
be draughty. 

"Besides the admission of pure air and the discharge of foul 
air, purity of atmosphere demands that no nursery nuisances 
be allowed to exist. It is better that no plumbing of any sort 
should be in the room itself. Bath and closet conveniences are 
very necessary, but should be a little removed and well venti- 



FRESH AIR, VENTILATION, OUT-DOOR EXERCISE. 289 

lated. In houses that are not plumbed, a place to which all 
offensive or soiled articles can be directly removed should be 
provided, which place should have free ventilation. In especial 
all soiled napkins and vessels containing evacuations or urine 
should be promptly removed, and in case of sickness a vessel 
should be provided in which the napkins or stools can be 
disinfected. 

"Under ordinary circumstances, however, disinfectants, in 
the usual sense of the word, have no place in the nursery nor 
in hygiene generally. A place that cannot be made wholesome 
by sunlight, air, and cleanliness should not be occupied. When- 
ever emergencies demand their use, they should be of the 
safest kinds consistent with efficiency, and after a contagious 
illness only the more costly contents of the nursery should be 
disinfected ; the cheaper ones can be burnt with greater ulti- 
mate economy. For this reason we always urge that toys be 
of the cheapest description, particularly if of such a kind as 
readily to conceal supposed sources of contagion. The paint- 
ing of walls and ceilings and the closely-laid floor already 
urged are of great assistance in promoting efficiency of disin- 
fection. . . . 

"The care of the hair consists in infancy chiefly in the care 
of the scalp, which must be kept strictly clean. If the vernix 
caseosa is as completely removed from the scalp at birth as 
from other parts of the person, there is usually little difficulty 
in preventing future accumulations. A soft brush should be 
frequently used upon the hair, a comb only as a separator for 
parting the locks and in emergency for disentangling. 

" The teeth require the same care as in adult life, but brush- 
ing should be of the gentlest sort, for fear of irritation of the 
gums, which may cause their subsequent retraction. In in- 
fancy after each feeding or nursing the gums should be washed, 
to prevent the formation of aphthous growths, and the teeth 
treated likewise as they appear. When the child is old 
enough to be quiet while the cleansing is done, a soft badger- 
hair tooth-brush should be used. 
n t 25 



290 MOTHER AND CHILD. 

"Dress. — The hygienic essentials of dress are — sufficient 
warmth without burdensomeness, uniformity of protection as 
far as consistent with activity, freedom, and, for children at 
least, softness. The problem of warmth without undue weight 
is best solved by the use of woollen garments. By reason of 
the poor conducting power of wool, such garments retain the 
bodily heat longer than those made of other materials. This 
slowness of conduction is greater in loose-textured fabrics. 
That is to say, a given weight of wool is warmer if loosely 
than if tightly woven. Hence the warmth of knitted gar- 
ments. The difference is due to the retention in the interstices 
of a certain amount of air, which is a poor conductor. For 
the same reason, two garments, two shirts for instance, are 
warmer than one shirt of weight equal to the two, and loose- 
fitting garments are warmer than tight ones. In hot weather, 
however, tight garments are distressing for other reasons. 
Linen stands at the other extreme of ordinary dress-materials, 
being the best conductor of heat. It follows that woollen 
garments give the best protection against change of temper 
ature and chilling, and in proper weight they make the safest 
dress in all places where temperature may vary or for all 
children who may become heated in play. Fashion or taste 
usually calls for outer garments of linen, but the protective 
garments should be beneath. The absorption of heat from 
the sun varies very much according to the color of the gar- 
ment, the material and texture being unchanged, white taking 
the least heat, or being the coolest, while black will absorb 
about twice as much. Singularly enough, the ' cool-looking' 
light blue is found by some experiments to be very nearly as 
hot as black. For very young children who are little exposed 
to the sun's heat this question of color is of minor importance. 

" Softness of material is essential for children on account of 
the sensitiveness of their skins. To most infants fine soft 
woollen shirts, either knitted or of ' baby flannel,' are seem- 
ingly entirely comfortable. Some, however, manifest unusual 
irritability of skin, and for such a shirt of fine linen should be 



FRESH AIR, VENTILATION, OUT-DOOR EXERCISE. 291 

placed within the flannel. This precaution is more often 
necessary in hot weather, when the flow of perspiration is 
increased. 

"The ordinary dress of very young children is objectionable 
in several ways. It is ordinarily unnecessarily confining about 
the body and limbs, although it has never in this country 
reached the degree in this respect that seems- to be usual in 
some Continental countries. There is also an unnecessary 
number of layers of fabric involved, as they are not required 
for the child's warmth under ordinary circumstances. The 
process of dressing or undressing is really an ordeal to the 
infant, as it is alternately rolled upon its back and belly in 
the nurse's lap, in order that one band after another shall be 
fastened by pins or stitches. Yery much of this dressing 
is unnecessary, if not harmful. First of all is the ' band,' a 
girdle enveloping the trunk from about the nipples to the iliac 
crest. Such an appliance may possibly be useful during the 
healing of the navel ; afterwards it is not of use if tight. 
The abdomen needs no support in health, the compression 
of the ribs is not advantageous, and so far as such a girdle 
affects the question of hernia (which it is popularly supposed 
to prevent) at all. it rather favors the production of the in- 
guinal or femoral variety. A loose girdle worn to prevent 
chilling is, however, often advisable in hot weather; and in 
cold weather a flannel girdle, or binder, ' cut bias' to secure 
elasticity, makes a useful envelope for the entire trunk of 
very young children as a preventive of bronchitis. 

" As a means of getting rid of the objectionable features of 
the ordinary dress, the writer has for some years recommended 
the following plan 1 or some modification of it. There are 
three garments (besides the napkins), all covering the neck 
and shoulders and reaching ten or twelve inches below the 
feet. The outer garment, as well as the middle one, is a little 

1 •' This plan was originally devised by Dr. Grosvenor, of Chicago, for 
use in his own family, and subsequently published by him. 



^92 MOTHER AND CHILD. 

larger in every dimension than that beneath it, so that no 
binding shall take place. They are all cut in the girdle-less 
pattern called 'Princess.' The inner one has sleeves, and 
may be made of cotton flannel or very soft wool flannel ; if 
wool is used, care must be taken against shrinkage in washing. 
The next garment has no sleeves, and no seams at the arm- 
holes, to insure against pressure there ; the material is wool 
flannel. The outer one is the usual dress, with high neck and 
sleeves, the details of which may be modified to suit taste. 
Thus, except the sleeves, the thickness is the same throughout. 
At night a garment like the inner one above described and a 
napkin only are worn. These three garments are placed one 
within the other before the dressing commences, pains being 
taken to avoid wrinkles and folds, and they are put upon the 
child as one garment with very little trouble. They are 
removed with equal ease. 

"The napkins may be of any suitable kind, — i.e., soft and 
absorbent material, easily washed. Linen has no real advan- 
tage ordinarily over cotton, except aesthetically. Old linen 
is soft, but likely to be thin. It is desirable to diminish the 
bulk of the napkins as far as possible, to prevent uncomfortable 
pressure: this is accomplished by having a small napkin 
simply to cover the seat and genitals thick enough to retain 
the urine or faeces, covered by another one not thick, but large 
enough to envelop the hips. The age at which napkins may 
be discontinued depends upon circumstances. Among English 
families of the better classes, apparently, children are taught 
to make their needs known earlier than is usual with us. 
Much can be done by an attentive and intelligent nurse who 
holds the child over a vessel with suitable frequency. But 
children vary greatly in this particular, and under no cir- 
cumstances is any severity justified, or even scolding, as 
nervousness or anxiety on the part of the child simply aggra- 
vates the trouble. As soon as the child can regularly give 
notice of its wants in this respect it is better to discontinue 
the diaper, as its absence gives greater freedom to the limbs. 



FRESH AIR, VEATILATION, OUT-DOOR EXERCISE. 293 

Of course at all times napkins should be changed as soon as 
discovered to be damp or soiled. Eubber or other impervious 
covers for diapers should not be used. Even the exigencies 
of a railway-journey, with the conveniences usual in this 
country, do not require their employment. They simply 
convert a wet napkin into an unclean fomentation. 

* : When a child begins to use its limbs freely, the clothing 
should be shortened. In fact, there is no real need of long 
clothes at any time, except to save labor in keeping the in- 
fant's feet covered. When it begins to creep, its manoeuvres 
are facilitated by slipping over its skirts a loose baggy pair 
of breeches of woollen which is tied around its waist and 
buttoned about its knees. This keeps the skirts from im- 
peding its progress, and protects it against floor-draughts 
in a measure. 

"The dress of older children should conform to the same 
hygienic requirements as given above. The two most fre- 
quently disregarded are freedom from constriction and uni- 
formity of protection. The former is violated by the use of 
tight girdles, or even by corsets, tight sleeves, garters, and 
misshapen stockings and shoes. Their harmfulness is well 
understood : the neglect is usually a wilful preference of fash- 
ion to healthfulness. The same might perhaps be said of the 
fashion of unevenly distributing the clothing over the person ; 
but the injurious effects of this are less understood. Chilling 
is resisted far better if the whole person is exposed to the 
same temperature than if one part is exposed to a lower 
temperature than another. It is a matter of universal experi- 
ence that many persons who rejoice in out-door life even in 
severe weather are directly injured by a draught and by 
sitting near a window. Yet formerly more than now low- 
necked dresses were used for children, the entire shoulders 
being exposed, while the remainder of the trunk was burdened 
with dress. At the present time fashion exposes the legs 
more. Shoes and stockings are often too thin, but in par- 
ticular children are too often dressed with the lower limbs 

25* 



294 MOTHER AND CHILD. 

bare from above the knee to a little way above the ankle, the 
foot being covered by a slipper. The difference is often aggra- 
vated by too much clothing on the body and a sash over all. 
The lower limbs should be thoroughly clad, — not cumbrously, 
but warmly. The stocking of a child old enough to run about 
should be long enough to meet or be overlapped by the next 
article, napkin or drawers, as the case may be. Stockings of 
wool, for the reasons already given, are to be preferred. 
They should be soft. They should not be pointed, at the 
toes, but be wide enough to admit of ample play in every 
direction of the anterior part of the foot. Color is not indif- 
ferent, as some dyes have been found to produce eruptions 
on the skin. Public attention has, however, been so thor- 
oughly drawn to this subject as to have led in some instances 
to legislative enactments, and such dyes are probably less 
frequently used than formerly. Aniline reds have been thought 
to be especially irritating. 

" Shoes of proper shape are not easy to get for children ; not 
nearly so easy as for adults. This comes probably partly 
from the supposed necessity of making them for a low price 
and partly from a belief, often openly expressed, that 'a 
baby's foot has no shape.' The real shape of the human foot 
is followed in the true ' waukenphast' shoe, but this we have 
never seen of proper sizes for infants or young children. It 
is not enough that a shoe should be as wide or wider than the 
foot, but it should have its width rightly disposed: space 
where the foot does not demand it in no wise compensates for 
pressure elsewhere. The result must inevitably be a distortion. 
In choosing shoe3 for infants it is better that they should be 
unduly long, if that be necessary to obtain the requisite width 
in front, than that they should be narrow." 

The following, taken from Miss A. M. Bacon's fascinating 
book on "Japanese Girls and Women," will be of interest. 
Writing of the Japanese baby, she says, " It is not jolted, rocked, 
or tossed to sleep ; it is allowed to cry, if it chooses, without 
anybody supposing that the world will come to an end because 



FRESH AIR, VENTILATION, OUT-DOOR EXERCISE. 295 

of the crying ; and its dress is loose and easily put on, so that 
very little time is spent in the tiresome process of dressing 
and undressing, . . . and it is not subject to fits of hysterical 
or passionate crying, brought on by much jolting or tossing, 
or by the wearisome process of pinning, buttoning, tying of 
strings, and thrusting of arms into tight sleeves. 

" The Japanese baby's dress, though not as pretty as that 
of our babies, is in many ways much more sensible. It con- 
sists of as many wide-sleeved, straight, silk, cotton, or flannel 
garments as the season of the year may require, — all cut after 
exactly the same pattern, and that pattern the same in shape 
as the grown-up kimono. These garments are fitted one 
inside of the other before they are put on, then they are laid 
down on the floor and the baby is laid into them ; a soft belt, 
attached to the outer garment or dress, is tied around the 
waist, and the baby is dressed without a shriek or a wail, as 
simply and easily as possible. The baby's dresses, like those 
of our babies, are made long enough to cover the little bare 
feet, and the sleeves cover the hands as well, so preventing the 
unmerciful scratching that most babies give the face, as well 
as keeping the hands warm and dry." Would that some bold 
and brave mothers would make fashionable such baby-dressing 
in this country ! 

By way of contrast we will quote the following : 
Dr. W. Thornton Parker, writing of American Indian 
women, says, "As soon as the Indian baby is born it is 
placed in a coffin-shaped receptacle, where it passes nearly 
the whole of the first year of its existence, being taken out 
only once or twice a day for washing or change of clothing. 
This clothing is of the most primitive character, the baby 
being simply swaddled in a dressed deerskin or piece of thick 
cotton cloth, which envelops the whole body below the neck. 
The outside of the cradle varies with the wealth or taste 
of the mother, scarcely two being exactly alike. Some are 
elaborately ornamented with furs, feathers, and bead-work, 
others are perfectly plain. Whatever the outside, the cases 



296 MOTHER AND CHILD. 

themselves are nearly the same. A piece of dried buffalo hide 
is cut into proper shape, then turned on itself, and the front 
fastened to a board or, in the most approved cradles, to two 
narrow pieces of board joined in the form of an X. 

" It forms a real ' nest of comfort,' and, as the Indians are 
not sticklers on the score of cleanliness, it is the very best 
cradle that they could adopt. To the board or boards is 
attached a strap, which, forced over the head, rests on the 
mother's chest and shoulders, leaving the arms free. 

" When about the lodge the mother stands the cradle in some 
out-of-the-way corner, or in fine weather against a tree ; or if 
the wind is blowing fresh it is hung to a branch, where it 
fulfils all the promise of the nursery rhyme. When the baby 
is ten months old it is released from its confinement and for a 
year or two more of its life takes its short journeys on its 
mother's back in a simple way." 

The question is often asked, at what age a child should go 
out of doors, and whether it should go out every day, not- 
withstanding the weather. It makes a very great difference 
whether the parents live in the country or the city. Country 
children, of course, are out most of the time, as they grow 
older especially; whereas, in the city, the impossibility of 
thus turning them loose and the necessity of a nurse to accom- 
pany them are matters that have to be taken into consider- 
ation. After a babe is about six weeks or two months old, 
if the weather be at all moderate, the nurse can wrap the 
child well and take it in her arms out for a walk. There is 
less risk of young children taking coid than older ones, from 
the fact that they are much easier wrapped- and kept warm, 
and the nurse is able to carry them. At the same time, if the 
house is well ventilated and warm and the weather cold and 
changeable, — dirty streets, snow, and dampness rising from 
the ground, — it is far better for the child to remain in the 
house. As soon as a child arrives at the age when it is a drag 
upon the nurse, is difficult to carry, and at the same time 
cannot walk, and a perambulator is required, the time to exer- 



FRESH AIR, VENTILATION, OUT-DOOR EXERCISE. 297 

cise the most judgment has come. Any mother can see this 
for herself by going to one of our city parks and watching 
the congregation of nurse-girls there assembled, noting the 
position of the baby carriages and the condition of their occu- 
pants. A child will be left facing the bleakest March wind, 
or the midsummer sun fiercely attacking its unprotected 
head, while the nurse is engaged in conversation with a 
number of her friends. We have often been at a loss to under- 
stand how mothers could select these young, inexperienced 
creatures to take care of their children, knowing full well 
what would be the consequences, and then be surprised if the 
child should be taken with a severe sore throat, earache, pneu- 
monia, or inflammation of the brain. It would be far better if 
all children, until they are old enough to sit up by themselves, 
were carried by their nurses On their every-day outing, and 
that after a child is too big to carry, and too young to 
walk, it should sit up in its carriage, well wrapped, then the 
nurse take a long walk, with the distinct understanding that 
under no circumstances is the carriage to be stopped ; when 
she is tired she is to come home. We are very particular in 
laying stress upon this matter, because, notwithstanding all that 
has been written on the subject and the full knowledge that 
mothers obtain from their family physicians, who are one and 
all opposed ta the present system and acknowledge that a 
larger part of the diseases of children is due, undoubtedly, to 
the carelessness, in oneway or another, of their nurses, — these 
girls, without any experience whatever, with no judgment, 
certainly no affection for their charges, are hired and intrusted 
with the care of an infant, and are allowed to take it out, going 
where they will, to carry it into heated rooms, to leave its out- 
door wraps on, to carry it out of doors while it is perspiring, 
and to expose it to contagion of every kind, taking it into all 
sorts of atmospheres ; and yet, after the child has been returned, 
its fond mother will fondle and caress it, guard it against the 
least exposure, treat it as the tenderest flower, and be struck 
with wonder and surprise when it is taken ill. So important 



298 MOTHER AND CHILD. 

do we deem it that a child's nurse should be selected with the 
greatest possible care, that she should be a woman chosen on 
account of her experience, conscientiousness, and truthfulness, 
that we believe the mortality from contagious diseases, and 
from those disorders due to direct exposure, would be dimin- 
ished if mothers could be made to appreciate this matter. 



CHAPTER XXXIX. 

BATHING. 

The child should be gently washed in warm water with a soft 
sponge, or soft linen, with Pears' non-scented or with Castile 
soap, and care should be taken that every part of the body 
be carefully washed, so as to free it from any impurities that 
cause irritation to the tender skin ; the nostrils, the eyes, the 
mouth, the various crevices of the groin, the armpits, and 
the genitals should be thoroughly cleansed. 

There should be a thermometer in the nursery, and the 
child's bath should be always regulated by it. The tempera- 
ture of the water should be such as to give a sense of gentle 
warmth to the hand, and as the child grows older and becomes 
strong, the circulation well established, the temperature should 
be gradually reduced until it is about 75° F., or cooler. It is 
not at all necessary that a child should receive a full bath twice 
a day; once a day is amply sufficient, — in the morning. A 
child should always delight in its bath ; when it is old enough 
to have its tub, the bathing should be made a pleasure to it. 
Give it something to play with in the water ; make a frolic of 
it. Should it at first dread the bath, be careful not to frighten 
it ; place a blanket over the water and let the child gradually 
become surrounded by water by immersing it with the blanket. 
Always wet the head first, even with babes. At bedtime a 



BA THING. 299 

sponging off will be enough, unless the child possesses one of 
those excitable dispositions to which we have already alluded, 
— is the child of intellectual parents, those who depend upon 
their brains for a livelihood : these children always exhibit 
a more or less nervous, irritable disposition, which renders 
them at times restless and sleepless. For such, the sedative 
effect of a bath at night is most marked ; indeed, for these it is 
well to usually sponge off with cool water in the morning, and 
leave the bath for the night, making the water about blood- 
heat in order to get its full sedative influence. 

It is a very great mistake to accustom a child to bromide, 
valerianate of ammonia, brandy, or gin, to make it sleep ; 
these should never be used without the consent of a physician; 
but the sedative influence of a warm bath, or warm foot- 
bath, can never be harmful. The usual time for giving the 
morning bath is about nine or ten o'clock ; at this time diges- 
tion is not going on, as a rule, and the child can be thoroughly 
washed, the surface being brought to a glow either with the 
hand or with a soft towel ; the child may then take its bottle 
or breast, get its hour's sleep, and there will be still time for it 
to spend the best part of the day out of doors. Of course in 
summer, when the child should be out as much as possible, the 
bath may be given at an earlier or later hour, to suit the cir- 
cumstances. For a very young infant it is not absolutely 
necessary to give a bath in the tub ; the room should be 
warmed to a temperature of about 75° F., and guarded 
against draughts. 

The temperature of the bath, if the child is immersed, 
should be about 90° F., but if it is delicate and young a thor- 
ough sponging of the surface will be sufficient, and it should 
be gradually accustomed to the water until it will of its own 
accord show a liking for the bath. When travelling, a port- 
able bath, such as is figured in the plate preceding Part II., is 
a useful companion, and in these days of electric lighting a 
spirit lamp is a necessity, and should never be forgotten when 
leaving home. 



300 MOTHER AND CHILD. 

The question often arises, How long a time should elapse 
after feeding before the child has its bath ? Certainly not less 
than an hour, better if two hours should elapse after a heavy 
meal. Of course this refers entirely to a bath by immersion, 
but for a young infant that is simply sponged and nursed with 
breast-milk, an hour will be sufficient. 

It is often necessary to bring about a glow on the surface 
of the bodies of children who are delicate, when, for some 
reason or other, the bath cannot be given ; the. body should be 
gently rubbed with either spirits of wine or washing whiskey, 
to which a little salt may be added to make it more stimulating ; 
or, if the child is very delicate, cod-liver oil may be used, to- 
gether with rubbing. About a tablespoonful of a solution of 
Castile soap (scraped) dissolved in alcohol, to a basin of water, 
is frequently an excellent addition to the sponge-bath. This 
can be made up by the pint and kept for that purpose. 

The child should not be permitted to go out immediately 
after its bath, nor indeed for an hour or so, if the weather be 
cold; but as the day's sleep is taken immediately after the 
bath, scarcely any mother would be tempted to take her child 
out. Mothers ought to make it a rule never to take a child 
out of doors on an empty stomach ; not only will a child that 
has been given food before going out be better able to resist 
cold, but there will also be less chance of it becoming infected 
by contagious diseases. In most places children and delicate 
people should be in-doors at sundown ; the sudden chilling of 
the air renders it harmful, and at this time germs of malaria 
that have been carried upward by the warm day air are 
precipitated. 

If a child objects very seriously to its bath, it is far better 
to gradually accustom it to being immersed, and this can be 
readily accomplished as it grows older by teaching it to play 
in its tub, which should be gradually filled with water; or over 
the tub can be thrown a light blanket, and the child slowly 
immersed, gently lowered into the water. 

The question as to when a salt bath should be used is often 



BATHING. 301 

asked. This, of course, is a matter which, as a rule, should 
be left to the family physician to decide. Salt water is more 
stimulating than plain water ; it also has the advantage of 
being especially valuable in cases of chronic enlargements of 
the glands and tonsils, — a tendency to scrofula. Children who 
lack muscular strength, are troubled with loss of appetite, or 
who sleep badly, are especially benefited by salt baths. It is 
not necessary to obtain what is known as sea-salt, though this 
is usually sold for that purpose. A tablespoonful of ordinary 
salt to the gallon is about the strength of sea water. 

As children grow older the question arises as to the sea- 
shore and its advantages, especially sea-bathing. All children 
who are delicate, those that are scrofulous, those that are 
threatened with spinal curvature, or who have a tendency to 
become bandy-legged or pigeon-breasted, improve wonderfully 
at the sea-shore. As far as the bathing is concerned, surf- 
bathing or cold sea-water should not be used for children under 
three years of age ; until that time the sea-water can be given 
in the ordinary tub, to which has been added sufficient hot 
water to give it a temperature of at least 80° F. Any one who 
has spent summers at the sea-shore has certainly seen a great 
deal of the cruel practice of carrying a screaming, struggling 
infant in the arms and plunging it into the sea-water. We can- 
not imagine a more barbarous proceeding. The sudden shock 
from the use of cold water, the fright, is enough to bring on 
convulsions. A child at the age of two years may have its 
bathing-suit put on in the middle of the day, run in its bare 
feet in the sands, bask in the sunshine, get its feet wet in the 
cool sea-water, and receive very much more benefit than it 
would from a plunge into the ocean, even if that could be done 
without the struggle which usually accompanies this proced 
ure. Even for infants of a year old, sponging the neck with 
cold water and dipping the feet in the same, followed by brisk 
rubbing, will prevent in many cases the taking of cold. We call 
the attention of mothers to this point. It will be a very valu- 
able procedure, especially in our changeable winter climate, if 

26 



302 MOTHER AND CHILD. 

adopted every night before retiring, to prevent the many at- 
tacks of cold that are so annoying and prevalent. 

Sea-bathing is to be interdicted for rheumatic children, for 
those with asthma; skin-diseases, and fevers. Kidney-disease, 
irritable lungs, a tendency to bronchitis, and some chronic 
eruptions come under the same category. In the case of heart- 
disease, the stimulating atmosphere excites this organ to too 
rapid action and aggravates the disorder. Weak eyes are to 
be kept from the shore, where the air, impregnated with salt 
and fine sand, and the glare keep up a constant irritation. The 
same applies to ear affections, but with exceptions, which, how- 
ever, should be made only under the advice of a competent 
physician. Little consumptives do better in the interior, as 
the coast air is too damp for their weak lungs. 

Children with tubercular tendencies and those with chronic 
joint diseases should be sent for residence to such places as 
Colorado, New Mexico, or parts of Texas. The establishment 
of children's sanitaria and boarding-schools in these localities 
should receive attention. 

The action of the skin is so essential to good health, that 
w T hen a child is really ill, a simple sponging of the surface of 
its skin may not do any harm ; of course the water should be 
tepid, the room carefully guarded against draughts, and the 
child, after being thoroughly dried, should not be allowed to 
run out in the cold entries until the skin has entirely re- 
acted. The mother will often say, "Doctor, my child has a 
cold; shall I wash it?" We may answer that when these 
precautions are taken, the sponging of the chest and throat, 
with subsequent friction, is the best thing she can do for the 
cold. 

In regard to the use of cold water in nursery bathing, it is 
a great mistake to believe that a child should be sponged with 
cold water, notwithstanding its dread of it and the shock which 
it gives to its nervous system. A child should be made to love 
its bath, to look forward to it with delight ; it should have a 
big sponge to play with, and in a very short time, as it grows 



BATHING. 303 

older, it will gladly sit in the tub of water, splash around to its 
heart's content, and get sufficient exercise to avoid any chances 
of taking cold. 

In using soap, great care should be taken that it be pure, 
with no free alkali,, such as the ordinary common cheap 
soaps. That which is non-scented is to be preferred. After 
the child has been dried, in summer-time, its body shoul i be 
powdered with a little starch or talc powder, which has a 
soothing effect upon the skin ; or in winter-time its chest and 
back, and the folds of the skin in the groin and axilla, can be 
greased with a little vaseline, just enough to make the skin 
soft and pliable, and also to protect it from cold, 

There is one caution which we think is in place here : a bath 
in tepid or cool water for a short time is invigorating; a pro- 
longed soaking in warm water has precisely the opposite effect. 

If the child is debilitated during hot weather by the pro- 
longed heat, and a more stimulating bath than the ordinary 
cool one is required, a teacupful or two of cider vinegar may 
be added to the bath, with or without the addition of salt. In 
children who have delicate skins, the red spots or blotchy 
eruption which appears shortly after birth is usually due 
to too active use of soap and water immediately following 
their birth. This can be obviated by following the directions 
given when speaking of the washing of the new-born babe ; 
but very frequently a child's skin becomes dry, rough to the 
touch, and needs constant attention to prevent eruptions, 
especially the much-dreaded eczema of children. Such children 
should not have salt baths, except when advised by the physi- 
cian ; they need fresh air, plain food, and probably cod-liver oil. 



304 MOTHER AND CHILD. 

CHAPTER XL. 

TEETHING. 

The first lower incisors — that is, the two lower front teeth 
—are usually cut when the child is from six to seven months 
old. For some time previous it has probably been noticed that 
the child has been restless and uneasy, that its sleep has either 
been disturbed or it has been wakeful. Before this time the 
child's secretions have been pretty well established. The tears, 
the saliva, will probably flow readily ; indeed, such children 
usually cut their teeth with but little trouble. It is doubtful 
whether all the troubles that are associated with teething are 
really due to that condition. There is no question but that 
the pressure upon the delicate nerve-pulp beneath a tooth 
that is bound down by a thick capsule, and probably on top 
of that a congested gum, may give rise to serious trouble, 
amounting to convulsions or intestinal disturbance at times ; 
or the irritation which is produced may inflame the gum, and 
thus starting as a sore mouth, the dryness of the mucous mem- 
brane extends to the stomach, and is the starting-point of a 
severe catarrh or earache. 

As a rule, children suffer comparatively little with their 
early teeth; possibly because, while these are being cut, ihey 
are still nursing in many cases, or they have not yet had a 
large amount of farinaceous food added to their diet. Then, 
also, the large back teeth and the eye teeth cause far more 
pressure on the delicate nerve-pulp, more disturbance in the 
jaw, and therefore are followed by a greater degree of sympa- 
thetic derangement. This sympathetic derangement may 
show itself in excitement of the nervous system, especially at 
night, and be one of the most active causes of sleeplessness ; 
also in its action upon the glands that secrete the fluids used in 
digestion ; and it is on this account that the second summer is to 



TEETHING. 

Fig. 35. 

" c -w- :> 

Appearance of mouth at about seventh month. 

,0OOo. x 

Appearance of mouth at about tenth month. 



305 




Appearance of mouth at about fifteenth month. 




r 4 



r h 




Appearance of mouth at about twenty fourth month. 




Appearance of mouth at about thirtieth month. 
26* 



306 MO THER A ND CHILD. 

most mothers a dreaded time, as then a baby is usually weaned, 
and the slightest neglect in the preparation of its bottle 
will permit of the fermentation of the starchy material that 
faulty secretion prevents from turning into grape sugar. 

Nature's plan is to keep the gum softened by being soaked in 
saliva ; it also uses the bowels as a sort of safety-valve to relieve 
the congested nervous system. A large watery movement of 
the bowels will cause a shrinkage in the gums, by depriving 
them of water, and will often take the place of the lancet. 
Congestion may be present in the delicate nerve-pulp beneath 
the teeth, and give rise to annoyance, irritation, pain, and at 
the same time the gum above give no evidence whatever, by 
its appearance, of what is going on beneath. A child suffering 
in this way from its teeth will crave something to bite upon, 
but as soon as it takes the nipple of its bottle, its fingers, or 
even its thumb in its mouth, and bites upon it, it will suddenly 
throw it aside, and show evidences of pain. The relief that 
comes from the soaking of the gums is very great; it is said 
that children who suck their thumbs seldom have trouble, and 
yet thumb-sucking should be discouraged, as it certainly de- 
forms the mouth and renders the upper teeth prominent. 

By the time a child reaches two and a half years, it should 
have cut its entire twenty teeth. They are usually cut in 
pairs : first the lower two incisors, then the upper two, then 
the outside two above, then below, next to those first cut ; then 
skipping a space for the eye- and stomach-teeth, the others 
will come in turn. From the sixteenth to the twentieth month 
the eye- and stomach-teeth will be cut. By referring to the 
diagram (Fig. 35) this will appear plain. 

The cutting of the teeth by no means always follows in this 
order, nor indeed do we always find the first appearance of the 
lower incisors as early as the sixth or seventh month. Sir 
William Jenner has stated that if a child does not cut its first 
tooth within a year, it is an undoubted sign of rickets. 

We think it well here to make a few remarks on the sub- 
ject of rickets, that the mother may fully understand what is 



TEETHING. 307 

meant by the term. To some people no greater insult can be 
offered than to suggest that their children are rickety ; to their 
mind, the word seems to imply some constitutional taint to be 
ashamed of. This is a great mistake. So large a proportion 
of children have rickets to a more or less marked extent that 
physicians feel the necessity of impressing upon the community 
the great importance of attention to the very subjects to which 
this book is devoted. Eickets is a condition, the result of 
faulty nutrition; it is found among the rich as well as the 
poor. It is the result, in the latter, of exposure, starvation, 
neglect; in the former, the direct consequence of high pressure, 
nervous exhaustion, improper feeding, — in other words, negli- 
gence or ignorance. The mother who fails to nurse her babe, 
and turns it over to the tender mercies of an ignorant nurse 
and a bottle, should not be surprised if her child suffers in 
consequence. ISTo more, indeed, should one ignorant of the 
fact that starchy food w r ill ferment and be productive of harm, 
be surprised to see her child develop spine-disease or become 
bow-legged. 

By rickets we mean a disease of the nutrition of the body, 
whereby its natural growth and development are arrested, the 
formation of bone is retarded, and the pressure exerted by the 
muscles and the weight of the body causes deformities which 
later in the disease become permanent. This want of bone- 
deposit delays the formation of teeth ; the interference with 
nutrition causes wasting of the muscles, produces disorders of 
digestion, and also shows itself in affections of the lymphatic 
glands, the liver, the spleen, and the brain. Its causes are bad 
feeding, want of sunshine, dampness, want of cleanliness ; and 
yet so gradual and slow is the process by which this faulty 
nutrition shows itself, that many children who are seemingly 
strong and hearty will manifest signs of rickets towards the 
end of their early dentition. 

Rickets is in nearly all cases developed after birth, usually 
about the fifth or sixth month. 

As regards the normal growth of the child during the first 



308 MOTHER AND CHILD. 

year of its life, the average growth is about eight inches; 
during the second year about four inches, and at this time it is 
supposed to have attained half of its full adult height. As 
regards weight, at the end of the first year it has gained about 
three times its weight at birth, but during the second year it 
has only increased this by about one-third. 

We have endeavored to impress upon mothers the great 
importance during pregnancy of leading the sort of life that 
will give them good digestion, — plenty of fresh air and exer- 
cise, — and of a diet that will supply all the demands of nature. 
Otherwise, at this time they are the ones who will suffer ; 
nature will draw from them the material to supply bone to 
their infant. The nursing mother should also be most careful 
in her mode of life, knowing that the nutrition of two indi- 
viduals depends upon herself. Should the supply fail, one or 
the other will suffer. Infants deprived of the materials that 
go to the formation of bone (lime-salts) will develop rickets 
though they may be fat ; because excessive storage of fat is 
no evidence of health, but, on the contrary, is often evidence 
of faulty nutrition. The failure of the diamond-shaped open- 
ing on the top of a child's head to close before the end of the 
first year; the delay in cutting its first tooth until the expira- 
tion of this period ; the tendency to enlargements of the 
glands, especially the tonsils; disturbances of the bowels, 
especially that form where bile does not seem to be properly 
secreted ; the tendency to perspire at night about the head or 
neck, notwithstanding the fact that the child seems fat and 
well nourished, are all, particularly when found associated in 
the same case, evidences of rickets, and a child presenting 
these symptoms should at once have a change of air and diet, 
and be placed under medical treatment. 

These symptoms may occur in a child that is nursed by a 
seemingly healthy mother ; in fact, we often find that the 
healthiest looking woman may be the one whose milk is least 
nutritious. They are apt to occur in a child that has followed 
rapid successive pregnancies, are almost certain to take place 



TEETHING. 309 

should the mother while pregnant attempt to nurse a child, 
and will very frequently be noticed exclusively in children 
who have been nursed too long. Too early weaning, especially 
if the bottle be made up of starchy food improperlj- cooked 
or given in too large quantities, will be a cause of rickets. 
Such children will develop, besides the other evidences above 
noted, large bellies distended with wind, vomiting occasionally 
sour matter, alternating diarrhoea and constipation, and the 
stools will most frequently be found either chalky or putty- 
like, and containing quantities of mucus. If a child is late in 
cutting its first teeth, though rickets may not be present, 
there is something faulty in. its condition. By late, we mean if 
it has not cut its front tooth by the tenth month. Such a child 
should be carefully watched, and its diet freely supplied with 
bone-forming material ; it should be given Mellin's food with 
its bottle, or (Trommer's) extract of malt, without hops (a 
teaspoonful to the bottle). It should have a salt bath daily, 
its muscles should be exercised by daily gentle rubbing or 
massage, and under no circumstances should such a child be 
allowed to stand on its feet until it has demonstrated its ability 
to do so after the gradual strengthening of its bones and 
muscles by creeping. 

A great mistake is often made by permitting a child to 
creep in one position. These children also should be watched 
with care, that they receive no sudden shock, or blow, or fall. 
Spinal curvature may be the result ; distortion of their hip- 
bone or pelvis, — a serious matter if they are girls. Diseases 
of the lungs should be guarded against, as bronchitis, pneu- 
monia, etc., as the difficulty in breathing will press the weak 
ribs out of position and keep them so, making the child 
pigeon-breasted. 

We have dwelt at length upon this matter in order to show 
that what is usually attributed to difficult dentition — the head- 
sweating, digestive disturbances, sleeplessness — in many cases 
may have nothing whatever to do with dentition, the difficult 
dentition being simply a symptom in the course of the disease. 



310 MOTHER AND CHILD. 

Malnutrition is the true cause. There are certain disturbances 
(mechanical ones), that are caused by the pressure of the teeth 
upon the nerve-pulps beneath, that are especially noticeable in 
children of highly-nervous organization, those whose parents 
are brain-workers, and in these cases we are apt to have dis- 
orders of digestion, malnutrition, brain-excitement, resulting 
in sleeplessness and possibly convulsions. Especially do these 
conditions manifest themselves during; the cutting of the 
back teeth, as the molars ; also the eye-teeth and stomach-teeth ; 
the eye-teeth, so called because their cutting is usually accom- 
panied by more or less disturbance in the circulation of the 
brain and the upper parts of the face, giving rise to excite- 
ment, to sleeplessness, or to catarrh in the nose or in the 
eyes ; and the stomach-teeth because their cutting is usually 
accompanied by disorders of digestion. 

Sleeplessness and irritability seem a constant accompani- 
ment of the teething process. A new-born infant sleeps from 
fifteen to eighteen hours out of the twenty-four ; a child of 
two years should sleep with little interruption at least ten or 
eleven hours at night, and from one to two hours in the middle 
of the day. But sleeplessness is not always an evidence that 
the child is suffering ; habit has much to do with this condi- 
tion. A child should be prepared for sleep ; its hours should 
be as regular as clock-work, and under no circumstances should 
it be allowed to pass its sleep-time. Especially is this rule 
important during the time of teething. The reasons for the 
sleeplessness of many children are, first of all, our city children 
are of an excitable temperament; they do not get sufficient 
fresh air or exercise, and in consequence the fatigue which 
should naturally invite profound and peaceful sleep is accom- 
panied by a degree of excitement that prevents this. 

Sleeplessness from this cause can be remedied by attention 
to these matters. It is produced by exciting a child just 
before its sleep-time, especially after it has taken its bottle ; 
its bottle or bowl of food should be given the very last thing. 
The drowsiness which follows this meal, if once disturbed, will 



TEETHING. 311 

cause a wakeful night. Among the poor, the father comes 
home tired from overwork, and the family retire together at 
an early hour; with the well-to-do, the lights are all lighted, 
the older children have their romp, or the baby, if it be the 
first, has to have its half-hour of play with the father, and 
possibly the excitement of its brain may cause a restless first 
sleep and wakefulness for the greater part of the night. This 
is altogether wrong, and is undoubtedly the cause of many 
brain disorders. For cases of wakefulness from no apparent 
cause, a hot foot-bath will have a most soothing effect, or, if 
they still resist, the morning bath can be postponed until 
evening, giving a warm bath at this time, and a sponging in 
the morning instead. In these cases, a bottle of food as warm 
as the child can take it, consisting of Mellin's food and water, 
the proportions being a tablespoonful of the fuod and water to 
fill the bottle, which will put the child to sleep. If the wake- 
fulness is due simply to excitement, the child seeming perfectly 
well otherwise during the daytime, medicine should be avoided 
unless specially ordered by a physician. The habit of giving 
bromide, for no other reason than simply wakefulness, is a 
mistake. 

Another cause of sleeplessness is insufficient nourishment ; 
we sometimes see such cases, where the mother is gradually 
losing her milk ; its bulk remains probably the same, but it is 
losing its richness or quality. Children fed on condensed milk 
alone are sometimes underfed, from the fact that the milk is 
given too highly diluted. One part to twelve of water should 
be the strength up to the second or third month ; after that, 
about one part to ten or eight, as the child grows older, or, 
better still, increasing the quantity of cream, and from a pint 
and a half to a quart of the mixture in the twenty-four hours ; 
but if the child seems hungry after each bottle, give it more 
until it is satisfied. But we fear that among those who will be 
readers of this book the greater cause will come from over- 
feeding. A restless infant, and especially a child about a year 
old. who tosses in its sleep, cries out, mutters, dreams, is one 



312 MOTHER AND CHILD. 

who in all probability is receiving food in excess, or is certainly 
not getting rid of the surplus in a proper way. If the mother 
notices that a sleepless, restless child, at whatever age it be, 
has a furred tongue, that its breath is foul, that its urine is 
scanty, high-colored, or that it passes water very frequently, 
probably wets its bed at night, is constipated, and the move- 
ments are light and pasty, she will know that the child needs 
a laxative, to be followed by a change in its diet, — a dose of 
Husband's magnesia, about a quarter of a teaspoonful, or, 
probably better than all, a dose of castor oil, followed next 
day by a limited amount of milk, substituting chicken-broth 
and avoiding oatmeal or beef-juice until the bowels become 
more normal. Castor oil can be given in warm water in which 
has been dissolved a peppermint drop, or a tablespoonful of 
liquid soda mint, a preparation now so well known that it can 
be obtained at any drug-store. The " soda mint" compressed 
tablets should be kept in every house, as they are frequently 
useful for "hiccups" or slight indigestion, though for infants 
the liquid is better. This form of sleeplessness is most apt to 
be noted at about the end of the first year. With some chil- 
dren the constant diet of oatmeal without any variation, the 
daily use of the expressed juice of beef, and at the same time 
large quantities of milk, which at this period is not often much 
diluted, will bring about the form of digestive disturbance just 
mentioned, and a degree of nervous excitability that is often 
referred to the teething process alone. On that account 
barley is preferable to oatmeal. 

We often hear of children who are said to be suffering when 
cutting their back teeth, and upon investigation find that tliey 
are taking about a quart of milk a day, with a tablespoonful 
of Mellin's food in each bottle, an ounce or two of the 
expressed beef, possibly a bowl of oatmeal food, and in addi- 
tion are constipated, get no fresh air, — in fact, are city chil- 
dren, surrounded by all the disadvantages that our changeable 
and treacherous climate affords ; viz., overheated houses and 
impure air. A child of this sort, if given chicken-broth instead 



TEETHING. 313 

of beef-juice, less Mellin's food, thin bread and milk instead of 
oatmeal, allowed to drink freely of water, and given an occa- 
sional laxative, will soon cease to suffer with its teeth. Over- 
feeding — stuffing, even with good, wholesome food — is the 
cause of much of the. disorder and febrile attacks of children, 
to say nothing of the " sweets" that are permitted between 
meals. 

Sleeplessness may arise from pain ; especially is this the 
case in bottle-fed children, who suffer from neuralgia, muscular 
soreness, possibly vague rheumatic pains, supposed by many 
to be caused by the fermentation of the sugar or starches 
which they are unable to digest. A child that is fed upon too 
much sugar will develop acidity ; the same with starch ; this 
leads possibly to rheumatism, or rheumatic neuralgia, called 
growing pain, and eventually to rickets, restlessness, sleepless- 
ness, or sudden starting, soreness to the touch, no desire for 
exercise, peevishness, or possibly extreme pain upon move- 
ment. When the child is lifted suddenly, or is handled while 
dressing, it will cry, — all important symptoms of this con- 
dition. 

An extra-sensitive nervous system will probably cause 
neuralgia through the jaw and head, earache, in some chil- 
dren, from tooth-pressure ; this cause is recognized from the 
fact that these children will avoid anything placed in the 
mouth, even the nipple of their nursing-bottle. The gums 
may be slightly swollen, but not inflamed or in themselves 
tender, but the least pressure upon them with the finger will 
cause intense suffering. In a case of this kind, if severe, — the 
child restless, starts in its sleep, refuses food, — the gum should 
be lanced. A cross-cut that will open the capsule of the tooth 
will in a moment relieve the pressure. If this is impossible, a 
hot bath or hot foot-bath should be given, also an enema of 
warm water, and if the child still suffer, and the mother is 
away from the doctor, she may give two grains of bromide 
of potassium, or five drops of the elixir of the valerianate of 
ammonia, the latter to be repeated in the course of an hour, if 
o 27 



314 MOTHER AND CHILD. 

necessary. These are the cases in which the bromide of potas- 
sium, if given judiciously, is of the greatest value ; they 
present the purely nervous type, and the nervous system 
should be soothed by precisely the same mode of treatment 
that one would adopt for a severe neuralgic headache. The 
bromide may be given with a teaspoonful of syrup of lactu- 
carium, or a teaspoonful of orange-flower water. If the 
excitement is great, the child of a year old should take about 
four grains of bromide ; should a convulsion threaten or occur, 
the proper treatment i3 warmth and counter-irritation to the 
legs, and an enema of two ounces of water, at about the tem- 
perature of 100° F., containing one teaspoonful of the tincture 
of assafcetida. After the foot-bath the child's legs should be 
thoroughly wrapped in a blanket, and the only food given h 
for a time should consist of the blandest kind, such as barley- 
water, wine-whey, or chicken-tea. 

Dr. A. Jacobi, on the treatment of convulsions, writes as fol- 
lows : 

"Remove the injurious substances from the stomach. If 
vomiting have not occurred or not sufficiently, it should be 
provoked by tickling the fauces, and friction of the precordial 
[heart] region. These, as a rule, will suffice, but if they do not, 
quantities of warm water or mustard water will answer a good 
purpose. The syrup of ipecac is a doubtful and unreliable 
preparation. Purgatives should not be given in the begin- 
ning ; large enemata will act more favorably, as warm water, 
or warm water with antispasmodics, such as assafcetida, or 
local stimulants, such as turpentine. 

" Fever, unless it be high, requires no special treatment. As 
a rule, cold applications to the head will act well when there 
is a tendency to convulsions. Cold applications to the heart 
will reduce the temperature of the whole body. A warm bath 
will frequently do good. I do not adoise bathing or handling 
the child much while the convulsion is on. When thirst is very 
great, small quantities of ice-water should be given often, or 
Seltzer water, or Yichy or Apollinaris. 



TEETHING. 315 

" Solid food must not be given." 

A teaspoonful of the tincture of assafoetida in a teacup of 
water is the proper strength for an injection. 

Mothers should not give their children ipecac in this condi- 
tion, it being very irritating, and the strain produced by 
vomiting may be productive of harm. Ten drops of the 
aromatic spirits of ammonia, or ten drops of brandy, whiskey, 
or gin, in two tablespoonfuls of warm water, are Jar better, 
when given to the child as soon as it can swallow ; if there is 
any offending matter in the stomach, it will act sometimes as 
an emetic. 

There is another cause of restlessness and sleeplessness from 
teething, that due to the congestion of the gum and inflamma- 
tion of the mucous membrane of the mouth. We more fre- 
quently find this condition when the back teeth are being cut, 
and in children who secrete but little saliva. The gum is 
found swollen, red ; the mouth is dry ; the child will turn away 
from more solid food, and will eagerly drink water to allay 
the irritation in its mouth. Frequently, during the second 
summer, it will be accompanied by diarrhoea, from the fact 
that the mucous membrane extends to the stomach and bowel 
Yery often small ulcers (aphthae) form in the fold of the 
cheek or the surface of the gum, become coated with secretion, 
and are exceedingly painful. If there is disturbance in diges- 
tion, little round vesicles, which burst and form ulcers with a 
grayish coating, will form On the inside of the cheek or the 
lips, and on, or beneath, the tongue. These aphthae will 
annoy the child extremely, and produce sleeplessness ; they 
are the result of indigestion, not of teething, though fre- 
quently associated with it. The physician will probably give 
a little calomel and soda to correct the digestive disturbance, 
or the mother can give some magnesia, or from ten to twenty 
drops of spitted syrup of rhubarb with a teaspoonful or two 
of soda mint, given once a day until the bowels become reg- 
ulated ; at the same time the child can have its mouth washed 
gently with a soft piece of linen, with a solution composed of 



316 MOTHER AND CHILD. 

a pinch of borax, a teaspoonful of glycerin, and a tablespoon- 
ful of rose-water. 

The congestion of the gum of which we have been speaking 
causes the child to crave salty food ; indeed, this is an effort 
of nature to relieve this condition by inducing a flow of saliva. 
Lancing the gums will often be of great service, by the relief 
it gives to congestion ; the incision should be deep enough to 
cut through the capsule of the tooth ; instead of this the child 
should be given something to bite upon, and it will probably 
obtain relief in that way. The small bone of a well-boiled 
ham is salt, and the child will eagerly suck it and frequentry 
bite it. A chicken-bone, slightly salted, is also useful, or the 
child may be allowed to bite on a piece of rare roast beef, and 
possibly the eagerness with which it will seize upon it may 
cut the gum from below with the sharp points of its tooth. 
Children who suffer thus from their gums often get relief from 
Mellin's food, tied in a rag to suck or bite upon. 

To sum up, the object to be secured is the free flow of saliva ; 
it will relieve congestion and soften the gum. It is a mistake 
to rub a gum under such circumstances by hard, dry friction, 
but if the little one suffers so as to disturb its sleep, the 
mother's finger, dipped in the syrup of lactucarium, or even in 
paregoric and glycerin, ten drops to the teaspoonful, can be 
gently carried over the tender and inflamed gum, and, by 
gentle pressure, soothe instead of irritate ; and now and then 
a little firmer pressure may allow the point of a tooth to force 
its way through. Some children will eagerly suck a piece of 
ice wrapped in linen, and it will relieve the congestion of the 
gum. 

In these cases a hot foot-bath again has its advantages, by 
relieving the congestion of the head and mouth ; or, if the child 
is constipated, the operation of a laxative will be followed by 
relief to its congested gum. The latter will shrink, and a 
point of the tooth emerge from its captivity. 



DIET AFTER EARLY DENTITION. 317 

CHAPTEE XLI. 

DIET AFTER EARLY DENTITION. 

After a child has cut its twelve teeth, it is well to give it 
more solid food than that which it has been accustomed to take. 
The milk diet has been continued, or the bread and milk, up 
to this period, in addition to the mutton-broth, chicken-broth, 
or beef-soup, and our endeavor now should be to encourage 
the digestion of more solid food by gradually adding it to the 
diet to which the child has been accustomed. In almost every 
house is kept on hand what is known as stock ; this forms a 
very valuable addition to a child's dietary, as it is nutritious, 
palatable, and can be flavored so as to make a change. A 
child about two years old may have a more solid mid-day 
meal, composed of a piece of rare tenderloin or juicy mutton- 
chop, with some well-boiled rice or a thoroughly-roasted, dry, 
mealy potato, well minced, in addition to its soup, or the white 
meat of a tender fowl, or sweetbread finely chopped, first 
heated, though not fried. For its breakfast, instead of the 
bottle, a child of this age may take about a tablespoonful 
of cracked wheat (which must be thoroughly boiled or steamed), 
or oatmeal, or yellow corn-meal, or white grits of moderate 
consistency (thoroughly boiled), and milk. A little salt should 
be added to these while boiling ; this is preferable to flavoring 
with sugar. We think, indeed, it is better than using salt and 
butter ; butter used in that way will certainly upset a child's 
digestion. The sanitary foods (cereals) prepared at Battle 
Creek, Michigan, are useful in this connection. 

A soft-boiled egg, with bread and butter and a tumbler of 
milk (" cambric tea"), is about the best breakfast a child can 
have at this age. If it sits at the table and is taught to eat 
slowly, it will not become dyspetic. Between times, if the 
child is thirsty, a drink of milk is admirable. With its dinner, 

27* 



318 MOTHER AND CHILD. 

water is probably better; we have certainly found it so in 
children who are of a bilious habit. It is a great mistake to 
give a child sweet things before its meal; after dinner it may 
be allowed to have some mild dessert, light custard or pudding, 
sponge-cake, a baked apple, or, indeed (after it has cut its 
twelve teeth), a piece of ripe, raw apple or peach will have 
a good effect on its bowels. The great advantage of bring- 
ing a child to the table to eat with its parents is that it is 
taught to eat properly, to masticate its food thoroughly, 
which is the only way of avoiding dyspepsia ; and also, that 
the child can thus be trained to see but not ask for things 
that it knows it should not have. It is a great mistake to so 
spoil a child that it will refuse when at the table the proper 
sort of food, and cry constantly for that which is forbidden. 
A taste of this or that at the table may not result, for the 
time being, in an attack of indigestion, but the parents are sure 
to suffer for it in the future. We so often make the mistake 
of believing that children are rendered strong and healthy by 
inattention to these matters of diet and clothing, that care- 
lessness makes the child hardy, that the child who is strictly 
brought up is usually a sickly one. We acknowledge that at 
times great mistakes have been made by over-carefulness, that 
the scientifically-brought-up child is not always the most 
healthy. This carefulness may be carried to extremes, as may 
everything else. It is always well to make your list for the 
child's bill of fare as large as possible, and give it its choice ; 
but always adhere to the lines of digestibility, and avoid those 
articles that every one knows are absolutely indigestible or at 
least harmful and irritating, such as veal, pastry, unripe fruit, 
sweets in quantity ; and do not imagine that, because children 
sometimes escape the dangers which indulgent parents bring 
upon them, the words of advice only come from those who 
are too highly scientific in their ideas. 

The highly-educated classes and those who live by their 
brains alone are notoriously dyspeptic, and the children of 
these undoubtedly inherit the weak digestions of their parents 



DIET AFTER EARLY DENTITION. 319 

us they do their more highly organized brains and possibly 
larger heads. They are more subject to acute brain-troubles 
from this cause, and the}' are certainly more subject to all 
the influences which produce intestinal disorders, and cannot 
possibly digest the same food that will agree with a child of 
the same age, the offspring of the less intellectual and the 
laboring classes. This is a matter which every mother 
should thoroughly understand; it explains to her why one 
child will thrive on food that would be poison to another; 
it will prove to her beforehand, without the necessity of an 
experiment, that her child would not be made more hearty by 
feeding on the boiled potatoes, soggy bread, corn-starch, or 
apple-dumpling that has failed to kill her washerwoman's child. 
Nature has so constituted food that it is not all concentrated 
nourishment; in grain, in fruit, in meat, the easily digested 
portions are associated with certain materials that are harder 
to digest; in a mixed diet the various substances have dif- 
ferent degrees of digestibility, and in this way the digestive 
juices come more closely in contact with the food, owing to 
its bulk, and the muscular contraction of the stomach and 
intestines is promoted by the mass of material which passes 
through them. It would be, then, a mistake to feed a healthy 
person entirely on concentrated nourishment; the intestinal 
digestive juices would fail to be secreted, the liver would 
become congested and diseased, the bowels would be coated 
with mucus and would fail to act, and the refuse from the 
destruction of tissue, which is normally carried off by them, 
would remain behind and poison the system. But during 
illness, when digestion is checked, and when it is neces- 
sary to supply in small amounts the most concentrated 
nourishment to sustain the system of the patient, then the 
well-known preparations of peptonized foods, of concentrated 
meat-extracts, are not only most valuable but often absolutely 
indispensable. 

After it has cut its twelve teeth, the child will naturally 
desire a greater variety of food, and within bounds this de- 



320 MOTHER AND CHILD. 

sire may be satisfied. Its bill of fare should include articles that 
are easy of digestion, — mutton, beef, sweetbread, fowl of various 
kinds, soft-boiled eggs, scrambled eggs, or light omelet ; vege- 
tables, as carrots, spinach, young beans, young beets, asparagus, 
old potatoes, — the latter well boiled and mashed, or roasted ; 
by all means avoid parsnips, cabbage, turnips, etc. For fruits, 
baked apples, raw apples scraped, oranges (of course only the 
juice), grapes (avoiding the skins and seeds), peaches (pro- 
vided they are not picked green and then ripened) ; and avoid 
berries of every kind, also pineapples, green apples, etc. Figs, 
dates, and raisins are all bad for children at this tender age. 

The seeds of raw berries, also cherry-stones and chestnuts, 
are apt to lodge in a certain portion of the intestine and 
become impacted, thus giving rise to a serious disease that 
will require surgical interference. 

Dr. S. S. Adams, of Washington, has given us an interesting 
resume of the subject, and we will quote at length from his 
valuable paper : * 

" For convenience it is necessary to assume that the child 
has been deprived of the breast-milk at the twelfth month, 
and to formulate a dietary accordingly. The eruption of the 
lower central incisors, during the seventh or eighth month, 
seems to be the indication to mothers to begin supplemental 
feeding. Yery few infants pass far beyond this physiological 
epoch without it. . . . 

" The object being to prescribe a suitable dietary for the 
child, in health and disease, from weaning to puberty, it will 
be best attained by making divisions to conform to the recog- 
nized anatomical and physiological changes in the organism. 
The following divisions seem, therefore, to meet all the require- 
ments: 1, twelfth to eighteenth month; 2, eighteenth to thirty- 
sixth month ; 3, third to fifth year ; 4, fifth to eighth year ; 5, 
eighth year to puberty. 

" While most mothers will appreciate the value of milk as 
the chief food for infants during the first year, very few will 

1 Keating's Cyclopaedia of the Diseases of Children, vol. i. p. 337. 



DIET AFTER EARLY DENTITION. 321 

be convinced of its value as such after weaning. Several 
months before the child is weaned, in many instances, it has 
had some of the farinaceae, and also, probably, meat-broths. 
If weaning takes place before the eruption of the molars, the 
diet should be milk. If it is weaned during the summer 
months, milk should be its only food, although the molars and, 
perhaps, the canines have appeared. If, however, the child 
does not seem to derive sufficient nourishment from the milk, 
it may be given some additional food, provided the weather be 
cool, but always remembering that its chief constituent must 
be milk. If it seems to thrive on milk alone, it will be advisa- 
ble to limit it to it until the eighteenth month. It is the ex- 
ception, however, when a child will be satisfied with milk until 
this late period. It is generally necessary to supplement its 
food by adding some farinaceous aliment. If there is a ten- 
dency to loose bowels, barley-water is preferable. It is made 
by grinding a tablespoonful of the grain barley and adding to 
it six ounces of water : this should be boiled for fifteen or 
twenty minutes, salt added to suit the taste, and the mixture 
strained. This decoction should be made fresh twice a day 
and kept cool. It should be added to the milk in the propor- 
tion of one to three or one to two. The prepared barley may 
be used in the same manner, but it is not so reliable. If con- 
stipation is the rule, oatmeal may be used by preparing a de- 
coction similar to that of the barky. Arrow-root should not be 
used, on account of the large proportion of starch it contains. 

" Bread jelly has been highly recommended by Churchill and 
others as an excellent food for children just after weaning. 
It is made by taking a quantity of the soft part of stale bread, 
breaking it into small pieces, covering it with boiling water, 
and allowing it to soak for some time. The water is then 
strained off, and fresh water added. This should now be boiled 
until it becomes soft ; the water is then pressed out, and the 
bread on cooling will form a jelly. A portion of this should 
be mixed with sweetened milk. 

" In some cases beef-tea will be well borne. That made in a 



322 MOTHER AND CHILD. 

bottle swimming in a water-bath does not contain soluble albu- 
minoids. It contains large quantities of salts, and should not 
be given when there is a tendency to diarrhoea. Excellent 
beef-tea is made by mincing one pound of lean beef and add- 
ing a pint of cold water and ten drops of dilute hydrochloric 
acid. This should stand for two or three hours, with occasional 
stirring. It should then be left to simmer for fifteen or twenty 
minutes, when it will be ready for use. 

" Beef-broth is not very nutritious, and is not recommended. 
Mutton-, veal-, and chicken -broths are nutritious, and are appli- 
cable in many cases. It must be borne in mind, however, that 
mutton causes constipation, and veal diarrhoea. . . . 

" With the sixteen teeth the child should be allowed a more 
liberal diet. Its digestive apparatus is now capable of digest- 
ing food which has been masticated. It may be allowable to 
give it* stale, well cooked bread, and butter, or crackers. It 
may also be given a little mashed white potato, with gravy. 
A sandwich of scraped lean beef and bread, seasoned with 
salt or sugar, will be relished, and is very nutritious. It may 
have a piece of rare beef or a chicken-bone to suck, care being 
taken that it does not swallow the pulp or bone. 

" Peptonized beef preparations have been recommended by 
the recognized authorities. 

"In regulating the regimen of a healthy infant during this 
period, very little change is required in its food. It should be 
fed five or six times, at the same hours, every day, but should 
not be awakened for the purpose. If it desire its food before 
its accustomed time, it should have it. 

" First meal, 6 a.m. — A cup of milk, with cream biscuit or a 
slice of buttered bread. 

"Second meal, 8 a.m. — Stale bread, broken and soaked in a 
tumblerful of rich milk. 

"Third meal, 12 m. — A slice of buttered bread, with about 
half a pint of weak beef tea or mutton- or chicken-broth. 

" Fourth meal, 4 p.m. — A tumblerful of milk, with crackers 
or a slice of buttered bread. 



DIET AFTER EARLY DENTITION. 323 

"Fifth meal, 8 p.m. — A tumblerful of milk, with bread or 
crackers. 

" Towards the latter part of this period, when the child has 
sixteen teeth, it may be desirable to substitute the following : 

" First meal, 6 a.m.— Bread or crackers, with a half-pint of 
milk. 

" Second meal, 8 a.m. — A tablespoonful of oatmeal, cracked 
wheat, or corn-meal mush, with milk, and a couple of slices of 
buttered bread. 

" Third meal, 12 m. — Bread-and-butter, milk, and a soft-boiled 



" Fourth meal, 4 p.m.— A piece of rare roast beef to suck ; 
mashed boiled potatoes, moistened with dish-gravy ; bread and 
milk ; and a small portion of rice, bread jelly, or farina. 

" Fifth meal, 8 p.m. — Milk and bread or crackers. 1 

" This is a modification of the diet laid down by L. Starr ; 
but the writer usually insists that the infant should be con- 
fined to milk, milk and barley-water, or milk and oatmeal- 
water, during this entire period. When his advice has been fol- 
lowed, the perils of the ' second summer' have been avoided. 

" Fruits and berries of all kinds should be interdicted. 

" Every case of infant-feeding must be regulated by its own 
indicated requirements. There is no uniform rule applicable 
to all. Each must be studied carefully, and that mode of 
feeding must be adopted which proves best suited to it. 

" The child should not be permitted to sit at the family table. 
It may have a separate table, where it can have its frugal 
meal without being tempted by unwholesome dishes. 

" The diet in sickness during the first period must be regu- 
lated by the nature of the case. It is impossible to prescribe 
a regimen suitable to all sick children. 

"Yomiting is unquestionably the most frequent symptom 
to be controlled. It may be due to overfeeding, or to some 

1 Often it would be preferable to give the fourth meal at three p.m., and 
the fifth meal at six p.m., especially in winter, so that the child can be put 
to bed by seven o'clock. — K. 



324 MOTHER AND CHILD. 

fault in the quality of the food. "When it is caused by over- 
feeding, a diminution in the quantity of food, as well as a 
longer interval between meals, will usually correct it. If it 
should be caused by a defect in the quality, this should be 
discovered and remedied. If the ejected matter is sour- 
smelling, the alkali must be increased. Frequently, forced 
abstinence will correct it ; and in many cases small quantities 
of food given every fifteen, twenty, or thirty minutes will 
have a salutary effect. 

" Diarrhoea is often the result of improper feeding. The food 
may be too concentrated, or its quality may be poor. "When 
it is due to too much solid food, the indicated treatment is to 
confine the patient to a liquid diet. If the quality of the food 
is not good, it should be improved. In many cases the addi- 
tion of barley-water to the milk will prove effectual in check- 
ing the diarrhoea. 

" Constipation may often be corrected by adding oatmeal to 
the second meal, or oatmeal-water to the milk. 

" It should be the invariable rule to confine children to a 
liquid diet as soon as any impairment of digestion or assimi- 
lation is noticeable or they become ill. Milk should always 
have the preference. It may be given pure, diluted, boiled, 
or, perhaps, predigested. In rare instances milk will not be 
retained by the stomach, or will be passed from the bowels 
only partially digested. In such cases a mixture of equal 
parts of milk and lime-water, given in teaspoooful doses every 
ten or fifteen minutes, will not infrequently be retained and 
digested. In some cases where milk cannot be retained, 
barley- or rice-water may be temporarily substituted. In 
other cases beef-tea, beef-essence, or beef-juice may be admin- 
istered in small quantities, frequently repeated, with marked 
benefit. Tea and coffee should not be allowed. 

" In weakly children the following may be given : l 

1 The following are very good recipes, recommended on high authority: 
For "beef-essence take one pound of beef free from skin and fat, chop as 



DIET AFTER EARLY DENTITION. 325 

" Chicken Jelly. — Clean a fowl that is about a year old, and 
remove the skin and fat. Chop it, bones and flesh, and put it 
in a pan with two quarts of water. Heat slowly, and skim 
often and carefully. Let it simmer for five or six hours ; then 
add salt and mace or parsley to taste, and strain. Set away 
to cool. When cold, skim off the fat. The jelly is usually 
relished cold, but may be heated. Give this in small quan- 
tities, very often. 

" Wine- Whey. — Boil three wineglasses of milk, and add a 
wineglass of sherry or port wine. Strain, and add a wineglass 
of warm water. A wineglassful of this may be given once 
or twice a day. 

" White Wine- Whey. — To half a pint of boiling milk add a 
wineglassful of sherry ; strain through a fine muslin cloth, 
and sweeten. A tablespoonful of this may be given every 
two or three hours. 

" Eighteenth to Thirty-sixth Month. — It is quite as important 
to regulate the diet of the second period as that of the first, 
but much more difficult. At this period the child is walking, 
and often helps itself to indigestible substances. It now has 
all its milk-teeth, and is capable of mastication. Its mind is 

fine as mince-meat and pound in a mortar with two tablespoonfuls of 
water. Put into an earthen jar with a little salt, cementing the edges of 
the cover with pudding paste ; then put the jar in an oven or tie tightly in 
a cloth and keep in a pot of boiling water for three hours. Strain through 
a coarse sieve. Give two or more teaspoonfuls. 

For chicken-broth take half a chicken, one quart of water, a small 
bunch of sweet herbs, one blade of mace, and salt to taste. Put into a 
saucepan and allow to simmer gently for one and a half hours, carefully 
skimming in the mean time. Then strain and cool. "When cool remove 
all fat from the surface. This may be warmed as needed. 

Mutton-broth is made by taking one pound of the scrag end of the neck 
of mutton, a small bunch of sweet herbs, half a turnip, and a little salt. 
Put into a stewpan and pour over it three pints of cold water. When it 
boils, skim carefully, cover closely, and allow it to simmer gently for an 
hour ; then strain, cool, and take off all fat. This may be warmed as re- 
quired. Pearl barley or rice may be added, but must be boiled thoroughly. 

28 



326 MOTHER AND CHILD. 

generally sufficiently active to be taught what edible articles 
it should have. Its power of masticating, its flow of saliva, 
its good digestion and assimilation, and its increasing bodily 
growth demand a greater variety of food. If it reach its 
second period during the summer, and have the appearance 
of health, and seem satisfied with its milk and simple food, it 
will be prudent to wait until cool weather to change its diet 
to a more substantial kind. 

" It is now admissible to allow it to eat at the family table, 
because the opportunity to begin its training early should not 
be overlooked. It can be taught to eat slowly, that certain 
articles are not suitable for it, and that it can have enough of 
the proper kind of food. When a child frets for different 
articles of food on the table it is generally because some impru- 
dent person has allowed it to taste them. If it is not tempted 
by tasting other, it will be contented with its simple food. It 
should be fed at least four times daily, and occasionally will 
require a few crackers or a slice of bread-and-butter between 
meals. 

"First meal, 8 a.m. — A portion of well-cooked oatmeal, 
wheaten grits, or corn-meal mush, with a liberal supply of 
milk ; cold bread-and-butter ; and a piece of finely-cut, tender 
beefsteak, or a soft-boiled egg. 

" Second meal, 12 m. — A bowl of chicken or oyster soup, or 
weak beef-tea ; milk, with bread or crackers, and butter. 

" Third meal, 4 p.m. — Eoast beef, mutton, chicken, or turkey ; 
fresh white fish ; mashed white potato, moistened with gravy ; 
bread-and-butter ; and rice and milk. 

" Fourth meal, 8 p.m. — Milk, with bread or crackers. 
" It may be necessary to give a glass of milk and a piece of 
bread-and-butter between the first and second meals ; and if 
the child is particularly hearty the same may be occasionally 
required in the early morning. Towards the latter part of 
this period fresh ripe fruits are admissible, provided due care 
is taken to prevent the ingestion of seeds and rinds. A pop- 
ular fruit is the banana; but the writer's experience has been 



DIET AFTER EARLY DENTITION. 327 

such that he considers it more productive of eclampsia than 
any other fruit, and consequently he cannot recommend it. 1 

" The meal-hours vary in different communities, so that those 
for children will be governed by the local customs. It may 
be necessary to givethe principal meal earlier than four p.m. 
It must be remembered, however, that most children sleep the 
greater part of the afternoon, so that if they eat dinner at two 
o'clock they will be asleep during the digestion of the bulk 
of the day's solid food; on the other hand, if the meal be at 
four o'clock there will be active exercise after it to aid di- 
gestion and assimilation. 

" It will need constant watching to prevent it from obtaining 
unsuitable food. 

" Frequently the neuroses, as eclampsia, ' night-terrors,' petit 
mal, and the numerous symptoms attributable to 'worms,' 
may be directly traceable to the presence of indigestible food 
in the alimentary tract. A brisk purgative seldom finds the 
' worms,' but generally allays the excessive exaltation of the 
nervous system by removing the offending material. 

" When the child is suffering from an acute disease, its diet 
should be limited to milk and beef-tea. In chronic ailments, 
or in protracted convalescence from acute disease, each case 
must be treated by its individual requirements, while good 
judgment will render valuable assistance in the selection of 
those foods which are easily digested and which possess the 
maximum quantity of nutritious matter to the quantity in- 
gested. In sickness, tea and toast are favorite articles, but 
only load the alimentary tract with in nutritious matter. 

" During the third period — from the third to the fifth year — the 
difficulty of regulating the child's diet will be great. It has 
now reached the a^e when its friends will humor it with 



1 The plantain, or banana, is brought to this country green, and on that 
account is indigestible. When picked ripe in its native land it is most 
digestible. It is said that a pound of ripe bananas is equal in nourishment 
to a pound of bread or a pound of steak. — E. 



328 MOTHER AND CHILD. 

knick-knacks and table-food of difficult digestion. It has 
twenty teeth, and its friends cannot understand why it should 
not have such food as a healthy adult can digest. A devoted 
mother, or usually grandmother, will argue that all her chil- 
dren, at this age, were fed from the table and were not injured. 
Such children lived in spite of mismanagement. Granting 
that its diet must be more liberal at this age, it must still 
be restricted, for even now the presence of indigestible or 
undigested food in the alimentary tract may be productive 
of reflex nervous disturbances. 

" Its activity and waste and repair demand an increase in the 
quantity of nutritious food. Three substantial meals a day 
will usually suffice, but occasionally a snack between meals 
will be required. While it is well to apply the rule of regu- 
larity, it is not always prudent to enforce it, especially if 
the child is hungry. The practice of children running to 
the pantry and helping themselves should be discouraged. 
In such cases children do not eat enough at the regular 
meals. 

"It is impossible to lay down <a bill of fare' for this period, 
but a frugal meal can be selected from the following : 



" BREAKFAST. 

" Corn-meal mush ; oatmeal ; wheaten grits ; hominy ; with 
plenty of cream. 

" Potatoes, baked and stewed. 

" Eggs, poached, soft-boiled, and omelet. 

"Fish, fresh, broiled. 

" Meats. — Beef hash ; broiled steak ; stewed liver and kidney ; 
lamb-chops ; chicken fricassee. 

" Tomatoes, sliced (occasionally). 

"Bread. — Cold, light ; Graham ; entire wheat ; corn ; muffins, 
plain and Graham (occasionally) ; corn- and rice-cakes. 

" Fresh ripe fruit may be given in moderate quantity. 

"Highly-seasoned food must be avoided. 



DIET AFTER EARLY DENTITION. 329 

" LUNCHEON. 

"Soups. — Oyster; bean; chicken; consomme. 

" Yegetables. — Potatoes, baked and stewed ; sliced tomatoes. 

" Meats. — Beefsteak ; lamb-chops ; cold lamb or mutton. 

" Bread. — Cold rolls and soda-crackers. 

" Fruits in season. 

" Eice and milk. 

" DINNER. 

" Soups. — Consomme ; noodle ; oyster ; cream of barley ; 
potato ; chicken ; and chicken stew. 

" Fish. — Fresh, baked, broiled, and boiled. 

" Meats. — Beef, chicken, lamb, and mutton. 

" Yegetables. — Potatoes, rice, cauliflower, macaroni, peas, 
tomatoes, beans. 

" Bread.— Well-cooked wheaten. 

" Desserts. — Eice and milk j light puddings ; ice-cream occa- 
sionally. 

"Fruits and berries in season (fresh and sound). 

" The regimen of the sick during this period does not differ 
very materially from that of the preceding, except that, gen- 
erally, a more generous diet may be allowed. If the illness be 
of a nature demanding liquid food, the principles already set 
forth will be applicable. In all cases of illness the food should 
be reduced in quantity and changed in character, although the 
patient may not be confined to liquids. As soon as the appe- 
tite becomes impaired, the child should be put upon a simple 
diet. Frequently, in children of this age, too much or dete- 
riorated fruit will cause digestive disturbances. Withholding 
the fruit for a few days will usually effect a cure. The child 
should always have its fruit selected for it. When sick, knick- 
knacks, jellies, and fancy dishes should be forbidden. If the 
illness be protracted, and the food be digested and assimilated, 
it should have the most nutritious aliment. This rule is 
especially applicable to scrofulous, syphilitic, rachitic, and 
tuberculous children. We need not wait for the manifestation 

28* 



330 MOTHER AND CHILD. 

of these diatheses. Ef there is good reason for suspecting 
their presence, the sooner the select diet is begun the better ; 
and, even if they are not latent in these children, the care in 
feeding will prove beneficial. 

" New troubles seem to arise during the fourth period which 
require close vigilance over the child's dietary. At this time 
the milk-teeth begin to decay, and the first of the permanent 
teeth make their appearance. The child has frequent attacks 
of toothache, the dread of which prevents him from properly 
masticating his food. Consequently, indigestion and diarrhoea, 
from bolting food, are of frequent occurrence. 

" Again, the child is old enough to be indulged by its parents 
with everything they eat: hence the impossibility of restrict- 
ing the diet as long as it is healthy. . . * 

" In sickness the general rule of restricting the diet according 
to the nature of each individual case is also applicable. 

" The physiological changes which take place during the fifth 
period would seem to warrant the statement that extraordinary 
care should be exercised in regulating the child's regimen be- 
tween the eighth year and puberty. . . . 

" The rules governing the dietary during sickness are similai 
to those for adults. 

" The use of wines and beers should be prohibited, and that 
of tea and coffee discountenanced. 

" In discussing the diet for children in the preceding pages 
the writer has not lost sight of the fact that some regard 
should be paid to the important factor of the circumstances 
of life. It is well in prescribing a regimen which has stood 
the tests of the laboratory to remember that such advice is 
given to a large number who are not able to incur the necessary 
expense of typical feeding. To prescribe such food as that 
hereinbefore recommended for the child of the laborer, whose 
wages are scarcely adequate to support his large family, would 
entail hardships on those whose affections are strongest for 
the weak and afflicted. The expense necessary to obtain cream, 
milk, and milk-sugar will not be considered by people of even 



DIET AFTER EARLY DENTITION. 331 

moderate circumstances, but will be difficult for the mechanic 
and impossible for the laborer. Therefore it is important in 
selecting a food for children, either well or ill, in the lower 
walks of life, to recommend that which will be healthful and 
of reasonable cost." - 

As thorough digestion and nutrition require fresh air, 
mothers should bear in mind the importance of letting those 
children that eat heartily keep out of doors as much as possi- 
ble. The overfeeding, even with nutritious food, in our hot 
American houses during winter-time, is undoubtedly one of 
the great causes of those disturbances of the liver which are so 
frequently met with. It is the same process almost that is used 
in the making of the pates de foies gras. The Strasburg geese 
are overfed and overheated. Constipation, which is so com- 
mon in these bilious children, cannot be overcome by laxatives 
or purgatives, and mothers should avoid their use or their 
abuse. Let a bilious child be allowed to drink water freely, to 
have a good run in the open air with its clothes sensibly loose, 
ride on its tricycle, play with its hoop, jump rope, and restrict 
its diet; the biliousness will then rapidly diminish and the 
bowels become regular. 

" After the eruption of the temporary teeth, the most impor- 
tant particular is their preservation. They should be pre- 
served (if possible) until they are replaced by the permanent 
set. If the temporary set are preserved, in due time absorp- 
tion of their roots takes place, the little crowns become loose 
and fall out, or can be easily extracted. Premature removal 
of the temporary teeth often causes irregularity of the per- 
manent teeth in this way. It is not that their removal 
shortens the maxillary bone, but when they do not occupy 
their respective place, the bone does not grow as it should, con- 
sequently when the permanent teeth are ready to be erupted, 
there is not sufficient room between the teeth for proper de- 
velopment, and they are forced out of their regular positions 

" It is a well-known fact that the structure of the deciduous 
teeth is more delicate than that of the permanent set, and 



332 MOTHER AND CHILD. 

they are almost invariably subject to decay, and the deposit 
of a calcareous salt, commonly called ' tartar.' This salt, or 
tartar, is a precipitate from the saliva ; it is often found firmly 
attached to the teeth near the gum margins. There are several 
varieties of tartar, but we will only speak of the kind most 
destructive to the deciduous teeth ; this is called 'green stain,' 
and is very deleterious to teeth-structure. When once allovved 
to deposit on the teeth, it gradually encroaches beneath the 
gums, causing irritation, inflammation, and finally suppuration ; 
periosteal trouble ensues, and other serious complications are 
liable to follow. In addition to this the green stain, as seen on the 
deciduous teeth, has the effect of chemical abrasion, which 
softens their structure, causing the teeth to waste away. When 
it is found to exist, it should be carefully cleansed off, and a 
suitable wash prescribed to prevent its recurring. 

"Lastly, we will call attention to the first permanent tooth, 
which is erupted when the child is in its fifth or sixth year, 
and is called the < sixth-year molar.' This is the largest of 
all the teeth of the permanent set, and gives prominence to 
the cheeks. This tooth is often mistaken for a temporary 
tooth, and as such allowed to decay ; in fact, we are often 
called on by the parents of the little sufferers to extract this 
tooth, and when we protest, they say, 'Why, is not that tooth 
soon to be shed ?' Indeed, they seem to bo greatly surprised 
when told that it is a permanent tooth, and very important 
to preserve the regular features of the face. When it is found 
that the teeth are decaying, they should receive the earliest 
possible attention. It is a common error to suppose that, be- 
cause these teeth are temporary, they do not require attention ; 
or if any anxiety is felt about them, it is that they are not 
allowed to remain too long in the mouth. When the child 
finds that by the act of mastication the food is forced in upon 
the nerve through the decayed cavity, and suffers violent pain 
from it, he will not try it again. They will swallow their food 
whole, causing indigestion and its attendant evils. Acidity 
of the saliva is the common cause of caries of children's teeth. 



DIET AFTER EARLY DENTITION. 333 

This may be determined by the test paper and corrected by 
proper treatment." 1 

Dr. E. T. Darby, of Philadelphia, 2 whose large experience in 
dentistry entitles his recommendations to earnest consideration, 
writes, — 

"the care of the teeth. 

"The care of the teeth should begin in infancy. As soon as 
the temporary teeth begin to make their appearance, they 
should receive the attention of the mother or nurse, while the 
child is still young; they may be cleansed daily with a soft 
linen or muslin rag, but as soon as the teeth are all present in 
the mouth a small soft tooth-brush should be used upon them 
once or twice daily. The child can early be taught the use of 
the brush, and not infrequently a child two or three years of 
age will become so habituated to its use that it will not feel 
comfortable until its teeth have been properly cleansed. Stains 
upon the teeth are not only unsightly even in the mouth of a 
child, but they may be of such a character as to be injurious 
to the teeth. The green or brown stains which are sometimes 
seen upon the labial surfaces of the teeth are usually the result 
of an abnormal condition of the oral secretions, and a micro- 
scopic examination will often show them to be of fungous 
origin. These stains when present should be polished off, 
either with a fine powder of precipitated carbonate of lime or 
with a pine stick dipped in fine pumice-stone. 

" Salivary calculus — or tartar, as it is commonly called — is 
found upon the teeth of all persons, although not to the same 
extent. It may be of various colors, either white, yellow, or 
brown or almost black. It is a calcareous deposit from the 
saliva, and, where mixed with mucus and other substances found 
in the mouth, precipitates upon the teeth in greater or less quan- 
tities. While salivary calculus does not injure the teeth them- 
selves, it has a very destructive action upon the gums, causing 

1 Texas Sanitarian, November, 1891. 

2 Keating's Cyclopaedia of the Diseases of Children, vol. ii. p. 932. 



33 J: MOTHER AND CHILD. 

them to become congested and inflamed and to recede from 
around the necks of the teeth, and the teeth themselves to loosen 
and fall out. Whenever it is found in the smallest quantities, it 
should be promptly removed, and the surface of the tooth to 
which it was attached thoroughly smoothed. The importance 
of thoroughly brushing all surfaces of the teeth cannot be 
overestimated. Comparatively few adults, much less children, 
perform this part of their toilet with anything approaching 
thoroughness : they simply cleanse with the brush the labial sur- 
faces of the teeth, leaving those surfaces which are more difficult 
to reach almost or quite untouched, and it is in these hidden 
places that deposits are found and that caries occurs. The 
young child should be taught the importance of picking the 
teeth with a quill pick after each meal, to insure the removal of 
all particles of food which may have lodged in the interstices be- 
tween the teeth, where, if allowed to remain, fermentation ensues 
and decay is almost sure to follow. The use of floss silk nicely 
waxed and passed between the teeth after each meal and always 
before retiring at night cannot be too highly recommended. 

" Dentifrices composed of precipitated carbonate of lime, pul- 
verized orris-root, pulverized myrrh, and cinchona bark, with 
the addition of a little pure. Castile soap, may be used once or 
twice daily, with the best results. Nothing adds more to the 
appearance of a child's face than a row of pearly-white teeth, 
and nothing detracts more than a mouth full of diseased, dis- 
colored ones. To attain the former a little care only is neces- 
sary in early infancy, because when the habit of caring for 
the teeth is once acquired it continues throughout life. 1 

"The temporary set of teeth are frequently the seat of caries : 
hence the importance of early dental treatment. The child 
of two years should be taken to the dentist, that its teeth may 



1 We wish to impress upon mothers the great importance of washing the 
child's mouth with clean water at least once a day. A soft tooth-brush 
can he used, or a clean linen rag, and we know of nothing better than 
listerine to use with it. 



DIET AFTER EARLY DENTITION. 335 

be carefully examined, and if decay has begun on any of the 
teeth they should be treated as indicated elsewhere. Periodi- 
cal visits at intervals of six months should be made to the 
dentist, to insure freedom from pain and the retention of the 
temporary teeth until they are displaced by the advent of the 
permanent set. 

11 At the sixth year of age the first teeth of the permanent 
set make their appearance in the jaw. These are the first 
four molars, and their position is posterior to the molars of 
the temporary set. Great ignorance, even among people of 
more than ordinary intelligence, exists in regard to these teeth. 
The belief is general that all teeth erupted in childhood belong 
to the temporary set, and it is not uncommon for these molars 
of the permanent set to be allowed to decay until all hope of 
saving them is doubtful or impossible before the dentist is 
consulted. They are the largest teeth of the dental series, and 
are situated where they perform the most important part of 
the masticating function, and their preservation throughout 
life is of paramount importance. Every mother and every 
person who has the guardianship of children should bear in 
mind, when the number of teeth in the mouth of a child ex- 
ceeds twenty (ten in each jaw), that all in excess of this num- 
ber are teeth belonging to the permanent series and should be 
watched with the greatest care. The loss of a single perma- 
nent tooth in early life may not necessarily be attended with 
inconvenience or injury, but more frequently than otherwise 
such a loss impairs mastication, mars the harmony of facial 
expression, and destroys the symmetry of the whole face." 

An excellent mouth-wash is the following: 

Thymol, three grains ; 
Benzoic acid, forty grains ; 
Tincture of eucalyptus, three drachms ; 
Essence of peppermint, twenty drops; 
Alcohol, three ounces. 
Pour enough in a glass of water to render it turbid, and use as a mouth- 
wash. 



336 MOTHER AND CHILD. 



CHAPTER XLII. 

THE BOWELS. 

It is very important that a mother should know what con- 
stitutes a normal condition of the bowels of her children. At 
birth, the intestines contain an accumulation which is car- 
ried off by the first milk, this milk being laxative in character. 
The first movements are dark in color and viscid. The pas- 
sages will then assume a yellow color, and in about two or 
three weeks will begin to get gradually solid, in part. The 
passages should have little odor, should not be sticky nor con- 
tain mucus, and should be liquid. According to Ellis, "the 
healthy motions of an infant vary from a light orange yellow 
to a greenish yellow, from yolk-of-egg color to that of a mess 
of mustard. The smell should never be offensive, but resem- 
bling that of sour milk." 

Up to three or four months there should be two or three 
or even four or five movements in the twenty-four hours; 
though many children are perfectly healthy who have but one 
movement in the twenty-four hours, even at this tender age. 
As soon as a child has had a movement from its bowels it 
ought to be changed, and it is well to thoroughly anoint the 
parts with vaseline ; anything that causes irritation of the 
skin — undue acidity of the passages, or too frequent passages 
from the bowels — will rapidly cause soreness, unless the parts 
be washed and then thoroughly greased. It is a very great 
mistake for mothers to use rubber or oil-cloth with the diapers, 
as it will draw or keep the parts in constant perspiration. In 
washing diapers soda should not be used. Grease is far better 
than powder to use on a child's skin. A little white vaseline, 
as before recommended, tallow, simple cerate, or lanolin, will 
make the best ointment. 



CONSTIPATION. 337 

As the child grows older the movements become less fre- 
quent ; by the time that it is six months old it will have about 
two passages in a day. These passages, of course, are not 
always exactly the same in a nursing child ; indiscretion on the 
part of the mother, the use of purgatives, or of certain articles 
of diet, will so affect her milk as either to cause vomiting or 
purging in her infant. The child's movements may vary in 
color, becoming greenish or variegated, or they may become 
dark or thin (watery), or again they may be very much con- 
stipated, hard, round, surrounded by mucus, or the passages 
may be white, looking like cheese. Constipation may be evi- 
dent from the very earliest movements of a child's life, and 
be extremely difficult to overcome. 

We will study the two conditions, — constipation and diar- 
rhoea, — and endeavor to point out the cause and remedy in each 
case. 



CHAPTEE XLIIT. 

CONSTIPATION. 

Owing to the smallness of the bowel and to its position in 
the infant, there is not that accumulation in the lower bowel 
which takes place in the adult, and which acts as a reflex, or 
sympathetic, irritant, causing the muscle to contract in order 
to have a movement. This reflex irritation, or desire to have 
a movement of the bowel, has a marked tendency to return at 
certain hours, — that is to say, to become a habit, — and when 
properly regulated at that period of a child's existence when 
the habit can be established,— when the child is a year old, for 
instance, — the tendency to constipation which may have ex- 
isted previously will rapidly disappear, especially as from this 
time forward thtf child's bowel gradually changes its position, 
which allows a greater distention to take place. The cause of 
p w 29 



338 MOTHER AND CHILD. 

constipation in an infant at the breast is, indeed, one of the 
most difficult problems to solve that we know of; at times it 
seems to be a hereditary condition, a lethargy of the intestinal 
nervous system, which fails to respond to irritation. The con- 
tents of the bowel are composed of many materials which 
have escaped digestion : curds, mucus, the secretions which have 
been thrown into the bowel to lubricate it or to help digestion ; 
the secretions from the liver especially, which are intended, 
first, to help digestion by aiding the absorption of fats ; second, 
to prevent decomposition, as bile is a great antiputrefacient ; 
third, the bile contains the refuse, the ashes, that have been 
thrown off by the liver from the use and destruction of tissue. 
These materials, if not thrown off by the liver, are poisonous, 
and give rise to the symptoms known as biliousness. ISTow, 
mothers must not make the mistake which is so prevalent at 
the present day, of imagining that constipation always means 
faulty action of the liver. If the child be constipated, the pas- 
sages white or chalky, if there be much flatulence or colic, if 
the tongue be coated, and the urine stains the diaper with a 
reddish hue, then there is a decided want of action of the liver, 
and the constipation has probably a cause which can be re- 
moved by appropriate treatment ; but frequently the liver 
itself may be working perfectly well, while a catarrh of the 
bowel, the result of cold or indigestion, may be seated at that 
part where the bile flows from the liver into the intestine, and 
the flow of bile be checked. 

The symptoms are very much the same in these two cases, 
although it is obvious that the cause is different, and the mother 
who recognizes the condition, but fails to comprehend the dif- 
ference, and who doses her child without the advice of her 
physician, may do an immense amount of harm. 

For these reasons we have throughout this work insisted 
upon the submitting of all such matters to the family physician. 
We are opposed to household works on medical treatment, 
except so far as they give general information and are part of 
a liberal education. Every physician knows that with an edu- 



CONSTIPATION. 339 

eated mother, who is thoroughly in accord with the doctor in 
his endeavors to understand the child's condition and treat it 
properly, the chances of success are greater than when the 
parent is ignorant of the many details which works of this 
sort impart. 

Constipation may be due to the character of the food, to the 
want of secretions in the intestines, or to the failure of the in- 
testines to contract and propel the material towards their out- 
let, — what is known, technically, as peristaltic action. An 
infant at the breast, or bottle especially, may be constipated, 
and every endeavor fail to give it regularity ; yet as soon as it 
begins to take solid food the bowels will immediately become 
normal. A mother should recognize these different conditions 
in order to be able to counteract them. If the constipation 
depends on the character of the food, its indigestibility, or the 
rapidity with which the water is absorbed, leaving an excess 
of solids or curds behind, the movements will be of a cheesy 
character, putty-like, the masses hard, lumpy ; possibly not dif- 
fering very much in color from what they ought to be, but sur- 
rounded by mucus, — in fact, very much resembling putty. The 
movements may be infrequent, or there may be quite a num- 
ber of very small movements, showing an irritability of the 
rectum, and this may be accompanied by what is known as 
the diarrhoea of constipation. This form of bowel-trouble is 
found especially in children who are weaned from the breast 
and who are on bottle-food, and its treatment consists in giving 
freely some of the broths, such as chicken, or beef, a cupful or 
two during the day ; in avoiding a heavy meat diet, or one 
composed exclusively of milk; and in giving the child its bowl 
or bottle of thin boiled bread and milk, using stale baker's 
bread and straining, and making it thin enough to pass 
through the nipple of the bottle, which should be larger 
than that ordinarily used. The child should have some prep- 
aration of malt or pepsin to aid its digestion : a teaspoon ful 
of wine of pepsin in a claret glass of water immediately after 
eating or just before, if the appetite is failing; and if the 



340 MOTHER AND CHILD. 

masses of matter passed still show indigestion, the child should 
take about ten drops of the aromatic syrup of rhubarb with 
five drops of the wine of ipecac, every night, in a claret glass 
of water, until the passages show, by their healthier color, that 
the bile is being secreted. 

For those children who have been weaned from the bottle 
and are taking thicker foods, — that is, solid diet, — it is a mis- 
take to give water too freely with their meals. The water 
should be given between meals, as in that way it not only sup- 
plies a need of the system, but it cleanses the stomach and 
bowel of undigested matter and mucus, aids, by its mechan- 
ical action, the passage of materials which should be dis- 
charged, and relieves constipation. For these reasons a glass 
of water the first thing upon rising in the morning is recog- 
nized as a laxative. If the child have much straining, it 
will be noted that the passages are streaked with blood ; this 
is caused by congestion of the mucous membrane, and can be 
avoided by the use of some soothing enema. A small hard- 
rubber syringe holding about one ounce may be filled with the 

following : 

Sweet oil, a tablespoonful ; 

"Warm water (100° F.), a tablespoonful; 

Pinch of salt. 

Mix thoroughly. 

This, given to the child at the time when its bowels should be 
opened, will supply something for the muscle to contract upon, 
and thus clear the mucus out of the lower bowel. If the 
mucus and streaks of blood still remain, thin starch-water, 
boiled, should be used in the same way. 

Another form of constipation is that which is simply due to 
want of propelling power in the bowel. In these cases a child 
will go for several days without a movement, although appar- 
ently in good health ; when moved, the passages are to all 
appearances perfectly normal, large, well formed. It is aston- 
ishing how much can accumulate in the bowel. Indeed, it is 
probable that most of the overfed, fat children of the well-to- 



CONSTIPATION. 341 

do in our large cities, who take but little exercise, consisting 
only of a daily parade with the nurse, and so dressed that it 
is impossible for them to get the amount required, have their 
bowels much distended with matters that finally undergo de- 
composition and are the causes of the blood-poisoning which 
foul breath, furred tongue, loss of appetite, languor, and drowsi- 
ness indicate, — all grouped under the synonyme of bilious- 
ness. A child needs exercise as well as fresh air. After its 
bath, if the room is warm and comfortable, it should be allowed 
to have a romp with its mother or nurse and not be cramped 
by clothing. Throw a blanket on the floor and let it kick to its 
heart's content, toss and roll, exercise its arms and back and 
chest; let nature have full play, and such a babe will grow 
strong and sleep and eat well. Flabby children are consti- 
pated simply through want of propelling power in the bowel 
or in the muscles of the abdomen. For these the treatment is 
generally divided as follows : the external, the dietetic, and the 
use of medicines. The external treatment consists in manipu- 
lating or kneading the abdominal wall. As this condition ex- 
ists in individuals from infants at the breast, we might say, until 
old age, — for it is almost as common with the parent as with 
the child, — the treatment, more or less modified, is useful for 
all. After its bath, the child should be placed on a blanket, on 
its back, on the mother's lap, and the abdomen gently rubbed, 
beginning by placing the palm of the hand upon the navel and 
rubbing with a circular motion gently but firmly until the 
surface is in a glow, at each movement increasing the size of 
the circle, like the rings in a pond after a stone has been 
thrown into the water. Soap liniment can be used, or cod- 
liver oil, or sweet oil, or even castor oil, externally, if constipation 
be marked. As the contents of the bowel descend on the left 
side, the movement should be from left to right. One good 
rubbing a day will frequently be followed by a movement of 
the bowels. This may be still further facilitated by placing the 
hand in the same way and shaking the abdomen. Of course, 
exercise will be of great service in this form of constipation. 

29* 



342 MOTHER AND CHILD. 

For an infant this can be secured by gentle manipulation ; for 
an older child, by passive exercise and the encouragement of 
out-door sport. 

The next form of constipation will include that which is due 
to derangements of digestion, probably induced by too highly 
stimulating food, or food which has a tendency to ferment and 
produce gases. Mucus will be secreted in the bowel when the 
intestine is irritated by food or cold, and instead of producing 
diarrhoea, which would have been the result had the intestines 
been inflamed, may cause attacks of vomiting, colic from flatu- 
lence, and the expulsion of gases which have an extremely 
offensive odor. The child's abdomen is swollen with wind, and 
the passages are usually offensive, possibly fluid, or they may 
be hard, dark-colored, and infrequent, accompanied also by a 
coating of mucus. Children that are fed largely upon eggs 
frequently suffer in this way, or those who receive a large 
amount of starchy food, not sufficiently boiled, which remains 
undigested in the bowel. The children lose their appetites, 
become peevish, restless, suffer from inordinate distention of 
the abdomen, and, finally, if the cause is allowed to continue, 
catarrh of the stomach and intestine and obstinate diarrhoea 
will follow. Of course, the treatment in cases of this kind is 
obvious : the diet should be regulated, and such harmless laxa- 
tives used as will relieve the child of the offending elements 
and re-establish its digestion. Stop all solid food for a day or 
two, also milk and starches ; put the child on broths, and give 
it a dose of castor oil, a teaspoonful or two. A tablespoonful of 
liquid soda mint should be made quite warm, castor oil mixed 
with this, and when the oil floats to the surface it can be readily 
skimmed off and given to the child by the spoon. Sweet oil 
may be used in this way for an infant, instead of castor oil, if 
preferred. If there is much vomiting in these cases, and food, 
such as broths or barley-water, is not tolerated, the nourish- 
ment may be given in small quantities, using fresh beef-juice, 
Wyeth's or Valentine's extract. Five or ten drops of whiskey 
or gin in warm water should be given every fifteen or twenty 



CONSTIPATION. 343 

minutes, or two or three drops of aromatic spirits of ammonia, 
or gum-arabic water and lime-water may be used for a time 
until the vomiting is relieved. Dr. Walker, of Brooklyn, 
recommends the following : 

Creosote, two drops ; 
Glycerin, two teaspoonfuls ; 
Water, a small tumblerful. 
A tablespoonful of this every hour. 

And if there is much colic he advises, — 

JSTo. 1. 

Aromatic catnip tea, two tablespoonfuls ; 

Tincture of assafcetida, ten drops ; 

Syrup (simple), two tablespoonfuls. 
Or No. 2. 

Aromatic spirits of ammonia, fifteen drops ; 

Essence of peppermint, ten drops ; 

Glycerin, a dessertspoonful ; 

Aniseed-water, two tablespoonfuls. 
A quarter to half a teaspoonful of one of these, in water, every fifteen to 
thirty minutes, if necessary, until relieved. 

Use hot foot-baths (mustard and water), and apply mus- 
tard poultices, consisting of half mustard and half meal, to the 
abdomen, or, if the pain should still continue, an enema of warm 
water, about half a pint or less, or one of hop tea. When 
colic and constipation exist, the mother should never give a 
purgative without consulting her physician, as twisting or 
constriction of the bowel may be the cause, but recourse should 
be had to the above-mentioned treatment, which can never be 
harmful, or to an enema. As regards constipation, we may 
also mention the fact that when it is obviously due to a want 
of expulsive power in the child, the use of suppositories is 
often of value, and when cautiously given they can be used 
for some months until the child has gotten into the habit of 
having the bowels moved daily at the same hour. These sup- 
positories may be made either of Castile soap, or coca butter 



344 MOTHER AND CHILD. 

with glycerin ; or the gluten suppository made by the Health 
Food Company is often very useful. It is a mistake to give a 
child laxatives and purgatives as a routine practice. Yary the 
diet; change its bottle-food from one thing to another; en- 
courage it to play; give it out-door exercise. These will 
often in themselves be sufficient. For older children bran, as 
crackers, is often laxative, or it can be made into bread for a 
change. 

Dr. C. A. Earle, writing on the subject, says, — 

"If an evacuation of the bowels does not occur within 
twenty-four or thirty-six hours after birth, a careful examina- 
tion of the anal opening should be made ; indeed, in some of 
the large lying-in hospitals a very small enema is given as 
part of the baby toilet at the first dressing. This demonstrates 
at once the perviousness of the canal. Next let the mother be 
examined for a cause of constipation, and, by changing her 
diet, seek to correct her .baby's habit. It may be necessary 
to administer a mild laxative to the mother, for, as a rule, 
simple constipation in the child should be overcome without 
giving it medicines or injections. 

" If the child has been provided with a wet-nurse, and is con- 
stipated, the question will arise as to the propriety of changing 
to a wet-nurse with younger milk, in order to furnish more 
colostrum and less casein. Of course everything of a consti- 
pating nature, including starchy foods, is to be excluded from 
the diet of mothers or wet-nurses whose children are consti- 
pated. 

" If, notwithstanding these directions, the habit persists, and 
the child has but a single dry passage each day, and this is at- 
tended with straining, some exceedingly simple remedy should 
be administered to the child. As the simplest of laxatives, I 
strongly recommend a little molasses or simple syrup in water, 
and when the passages are very dry and the child is known to 
perspire freely, we should suspect an insufficiency of water in 
its system, and to overcome this there is nothing better than 
pure water internally. If the measures already suggested do 



CONS TIP A TION. 345 

not give relief, of course other treatment must be adopted, and 
we come to consider local stimulants which may be introduced 
into the anal opening or into the rectum. Among them I notice 
the soap-and-gluten suppository (Health Food Company), mo- 
lasses boiled and moulded into little masses and introduced, and 
the nozzle of a syringe oiled and inserted and injections of very 
small quantities of glycerin or water or both combined. Bohn 
recommends as preferable to any of the foregoing injections 
of cold water three times if needed in each day, then twice 
a day, and finally once daily until the cure is assured. Other 
authorities advise cold water as an injection, to which may be 
added a small amount of common salt. If enemata are neces- 
sary, either warm or cold, use small quantities, one or two fluid- 
drachms, of water or from ten to twenty drops of glycerin, to 
which may be added a little water. Large injections of any 
fluid should be avoided. 

" By massage or gentle kneading of the abdomen over the 
colon (that is, along the outer edge of the abdomen and the 
motion from right to left) muscular action is stimulated and 
the desired results are frequently brought about. This process 
should be repeated two or three times a day." 

Dr. A. Jacobi writes, — 

" Constipation depending on lack of sugar, is very often 
speedily relieved by increasing the quantity of sugar in the 
food. This is the case, not only in artificial feeding, but also 
when the children are fed normally on breast-milk. Such 
mother's milk as is white and dense, and contains a large 
amount of casein, is made more digestible, and will produce 
better evacuations when a piece of loaf sugar dissolved in 
tepid water is given immediately before nursing. 

" Yery little medicine should be given in all these forms of 
constipation, in infants or children, The best.- after all, may be 
magnesia, as there is frequently too much acid in the intestinal 
tract of the young. It will at the same time neutralize the 
acid and relieve the bowels. Whenever an addition is neces- 
sary, rhubarb will suffice. In most cases an enema will be 



316 MOTHER AND CHILD. 

sufficient to relieve constipation. It should be given every day 
for a long time. There is a prejudice against rectal injections 
which is unfounded. They should not be given too hot, not too 
cold. They may contain a small quantity of salt, so as to make 
a two-thirds of one per cent, solution. 

" In those cases where constipation is very obstinate, the 
enema should be given through a tube from four to six to eight 
inches in length. Beyond that it is usually impossible to intro- 
duce a tube." 

Water plays such an important role in overcoming the con- 
stipation of bottle-fed babes that we will quote the following 
from Dr. Jacobi : 

" The free dilution of children's nourishment with water is 
demanded upon the following additional facts. Only to a 
certain limit will pepsin be furnished for digestive purposes. 
Probably a portion of this is not entirely utilized. A great 
quantity of water is necessary to assist in pepsin digestion. In 
artificial digestion albumin often remains unchanged until large 
quantities of acidulated water are supplied. Without doubt 
many disturbances of digestion are to be explained by a de- 
ficiency of water, certainly many more than are due to an 
excess of it, as it is so quickly absorbed. 

" For the reasons given, I advocate under all conditions a 
plentiful addition of water to children's food. In this connec- 
tion I would lay stress upon the fact that, as a rule, small 
children receive water only as they get it in their milk. Alike 
in summer and in winter, it is probable that the fact seldom 
occurs to a mother or a nurse that a child can be thirsty with- 
out being hungry at the same time. Certainly many a dis- 
comfort and even sickness in a child is conditioned upon the 
fact that it has been compelled to eat in order to get its thirst 
satisfied, and often has to suffer thirst because the over-stimu- 
lated and injured stomach will take no more nourishment at 
irregular and too short intervals. There are also normal prod- 
ucts of digestion capable of producing disturbances in the di- 
gestive process, chief among which is peptone itself. I have, 



CONSTIPATION. 347 

therefore, considered it necessary in preparing rules for the 
feeding of children, which the New York Board of Health has 
annually published and distributed since 1872, to insist upon 
giving infants, who cannot ask in so many words for it, an oc- 
casional drink of water, at least during hot weather. When 
there is the least ground for the supposition that the drinking- 
water is contaminated with germs of disease, or where it is 
unusually hard, it should be boiled before its admixture with 
children's food, whether the diet be of milk or a mixed one. 
In general it will give greater satisfaction to use the boiled 
water systematically even where there is no apparent urgency 
for it, for very young infants." 

There are times, however, when none of the simple remedies 
seem effectual; stewed fruit loses its power; enemata do not 
seem to reach the spot, and indeed they should not be forcibly 
given nor too frequently. In such cases we have found glycerin 
suppositories very effectual. They can be obtained usually at 
any drug-store, or can be prepared from the following formula : 

R Lanolin, 

Glycerin, aa gr. xxx ; 
Olei theobromae, 
Cerat. alb., aa gr. xv. M. 
Ft. supp. No. 1. 

When it becomes necessary to use medicines as laxatives, 
we have several articles that are simple yet valuable. Prob- 
ably the simplest remedy is a teaspoonful of glycerin. A small 
piece of manna, the size of a postage-stamp, dissolved in milk, 
is an old-time but often excellent laxative, as are also the syrup 
of rhubarb, the compound syrup of sarsaparilla, the syrup of 
senna. — though the latter is at times apt to give pain, — the 
elixir cascara sagrada, and the compound liquorice powder. 
Friedrichshall water and Eubinat-Condal water we have found 
very useful, though the taste is sometimes objectionable to 
children, but, strange to say, not nearly as much so as to adults. 
As a purgative nothing excels castor oil; a teaspoonful of 
aromatic syrup of rhubarb adds to its efficiency. 



348 MOTHER AND CHILD. 

For older children — those from six years upward — we have 
found the effervescent table-waters very useful at the mid-day 
meal (all children should have a mid-day dinner, and avoid a 
heavy meal at six or seven with their parents). When these 
waters, such as Apollinaris, Manitou, etc., are given, we believe 
the excess of carbonic acid gas should be allowed to pass off, 
as it only distends the stomach. 

It should be remembered that pure water is the best laxative 
of all. 

These suggestions are only made for those who cannot get 
medical advice ; this is frequently the case in the country or 
in the far West on ranches, and persons intending to live in 
such places should possess a medicine-chest containing such 
simple remedies as they may need. 



CHAPTEE XLIY. 

DIARRHCEA. 

This is one of the most important subjects for our consid- 
eration. The complaint varies from simple frequency in the 
natural movement to that most violent form which occurs in 
summer-time ; but as the one leads to the other, mothers should 
be instructed how to treat the earliest symptoms, so as to 
check them before there is any necessity for medical treat- 
ment. 

Indigestion is the one great common cause, and, as we have 
before noticed, indigestion is produced by improper food and over- 
feeding, or by those depressing conditions which surround the 
child and prevent the digestion of its food, allowing it to ferment 
and act as an irritant. All these causes may act equally as well 



DIARRHCEA. 349 

in winter as in summer, at the sea-shore or mountains as in the 
crowded cities with unhealthy surroundings, in older children 
as well as in infants ; but, as a rule, they are very much more 
active in the overheated atmosphere of our densely-populated 
city during the summer, and infants that are obliged to stay 
in town are much more depressed, have less vitality, and their 
food is more apt to be tainted by the germs. 

Overfeeding is so constantly a cause of diarrhoea that it 
deserves a few words of caution. Many young mothers believe 
that if an infant cries it is always an evidence of hunger ; this 
is by no means the case ; it may simply be thirsty. If it is 
nursed at the proper time and has received its usual amount, a 
few spoonfuls of water will often quiet it instead of having 
recourse to the breast or bottle. We cannot lay too much stress 
on the importance of water, especially in the summer-time ; 
when given judiciously and frequently it may often save the 
child an attack of summer-complaint. Give cool water; do 
not give iced water, but let it be pure, filtered always, and if 
there is the least suspicion of its purity have it boiled. Do 
not put sugar in it. 

Mothers should watch carefully the urine of their children ; 
if the child cries suddenly, in a rather shrill voice, which is 
characteristic, it has probably wet itself and should be imme- 
diately changed, and the parts thoroughly dried and slightly 
greased to prevent irritation. If there should be a reddish 
deposit on the diaper, it is an evidence of indigestion or 
want of water to dissolve these crystals of uric acid. In 
such cases the urine is usually scanty. It will be found that a 
teaspoonful of soda-mint solution in a small teacup of water, 
or lithia-water, which the child should drink freely or take 
from a spoon, will, if kept up for two or three days, correct this 
condition. 

The child will cry if its position becomes irksome, if it feels 

the cold, if its clothing irritates it, or if the bands of its clothes 

are too tight, owing to flatulence extending the abdomen. 

Frequently it will cry from irritation of the skin, due to what 

30 



350 MOTHER AND CHILD. 

is known as prickly heat. In such a case a little vaseline 
rubbed on will soothe it ; or if the cry be sudden and sharp, it 
will be noted to be one of pain. This is frequently caused by 
the passage of its water, and the doctor's attention should be 
called to the parts. All these matters should be taken into con- 
sideration and carefully investigated before the child receives 
more food than its regular nursing every two or three hours. 

Overfeeding is generally recognized by evidences of the 
insufficient digestion in the passages, or by the frequency of 
the movements, although they may not deviate from the nor- 
mal condition; or the stomach may become overloaded, and 
the uneasiness of the child following the taking of food, its 
restlessness during sleep, with possibly nausea or vomiting, will 
be the consequences. It is a fortunate thing that a child 
vomits very readily, as in this way food that disagrees with it, 
fermenting in its stomach, can be gotten rid of without passing 
through the intestines, which are so easily irritated by such 
material. If the symptoms just noted are present, the child's 
breath be heavy or sour, and especially if it is a bottle-fed 
baby, it will be well for .the mother to encourage vomiting. 
The simplest means of so doing is to give the child a glass of 
water, and then tickle the fauces (throat) with a feather or 
with the finger, making the child gag, or follow this by giving 
a half-teaspoonful of syrup of ipecac every fifteen minutes until 
vomiting is produced. 

The next form of diarrhoea for us to study is that produced 
by the food, It is a well-known fact that the nursing mother, 
living on certain articles of diet, can so alter her milk as to 
make it a potent cause of indigestion. It is also known that 
emotions — passion, fright — will so change the character of the 
milk as to produce the same effect. Also any irritation of the 
nipple producing in the child a sore mouth will be the starting- 
point of a catarrh of the stomach and bowel; this can be 
readily obviated by cleanliness, the use of borax, glycerin, and 
rose-water as a wash, and vaseline to the nipple to prevent 
cracking. "We have frequently observed the fact that a mother 



DIARRHCEA. 351 

can depart from this rule of careful dieting, on many occasions, 
without altering her milk in a way that would affect her own 
child ; whereas the same milk given to another child, should 
she act as a wet-nurse, would be followed by harmful results. 
The close sympathy -between mother and child is thus kept up 
after its birth. All physicians know of cases of infants at the 
breast that have suffered from violent attacks of diarrhoea 
and convulsions, the result of extreme emotion (fright or pas- 
sion) on the part of the wet-nurse. It is this, together with 
the high living to which they are unaccustomed, the sedentary 
occupation which encourages biliousness, carelessness in diet, 
and the inability to watch them in every particular as to their 
functional health, morals, and personal cleanliness, that renders 
wet-nursing so unreliable. 

Certain substances have a peculiar effect upon the milk. 
Castor oil taken by the nursing woman will purge the child ; 
mercurials will sometimes have the same effect ; onions and 
garlic will be noticeable in the milk and cause indigestion. 
Alcohol will find its way to the milk ; this fact has been taken 
advantage of by giving the mother malt extract, which not 
only aids her own digestion, but the alcohol which is in it in 
small quantities, and also the diastase or nutritive qualities of 
the grain, possibly stimulate the digestion of the child. 

The one potent cause of intestinal disturbance in children, 
in summer, is stale cow's milk; and by the word stale we mean 
any milk that has stood some time after milking, unless it has 
been boiled or subjected to sufficient heat and guarded against 
atmospheric impurities. Our own experience is that milk 
fresh from the cow — one that is healthy and clean and has 
been carefully fed — may be given to a child from a bottle 
without any manipulation, except slight dilution, and will be 
digested ; whereas the same kind of milk after standing several 
hours might cause intestinal disorder. It is the atmosphere 
which does this ; it contains germs of putrefaction which are 
very much more jx)tent in the summer, and which abound in 
our large cities. It is almost impossible to distinguish this 



352 MOTHER AND CHILD. 

tainted milk from that which is fresh and pure, the changes 
being so insidious. 

We have said that the diarrhoea of infancy and childhood 
included every form, from simple looseness of the bowel to 
cholera infantum. The healthy passages should have little 
odor, no mucus, no curds ; they should have the consistency and 
appearance of prepared mustard. Occasionally, from cold or 
slight indigestion, one or two passages may change in appear- 
ance j they may become greenish, variegated in color, or they 
may become more frequent and contain a few curds. If such 
be the case, and the child is nursed, a teaspoonful of swpet oil 
and one of solution of soda mint will often be sufficient to 
restore the passages to their normal condition. If the mother 
or wet-nurse show signs of biliousness, a dose of castor oil given 
to her will probably have a good effect upon the child. If the 
child is bottle-fed, and curds still appear in the passages, it 
is getting food too full of curd, or its digestion is weakened. 
In such a case the bottle should be omitted for one feeding, 
and some barley-water or weak chicken tea substituted, and 
•the child's digestion should be stimulated by giving five or ten 
drops of the wine of pepsin or a grain of a reliable pepsin in a 
tablespoonful of water, with five drops of whiskey, before the 
next feeding ; or as mucli of a powder containing equal parts 
of lacto-peptine and subnitrate of bismuth as will cover (not 
heaped) a dime. 

If the child does not seem desirous of food, under no circum- 
stances press it ; should it crave water, allow it to drink, but 
not iced water; if there is the least irritability of the stomach, 
give it a tablespoonful of lime-water or a teaspoonful of soda- 
mint solution every fifteen minutes or half-hour, until the 
stomach is settled and the child quiet. 

The evidences of catarrh of the stomach and bowel are pain, 
restlessness, heat of body and head, with unnatural coldness 
of the extremities, or there may be fever. The character of 
the pain is peculiar ; the child will cry out at intervals and 
draw up its knees ; the abdomen is tense, the muscles firm and 






DIARRHCEA. 353 

rigid, and distended by gas. The passages, in such a case, 
are usually liquid and contain curds, are lighter in color than 
normal, and have mixed with them large quantities of slime 
(mucus). The tongue is coated ; the child will probably crave 
water, if there is much heat or dryness of skin. jNow, this con- 
dition can be brought about at any time of year from exposure 
to cold or from irritating food, but it is usually found in the 
summer in bottle-fed babies. Should it be allowed to continue 
for any length of time and the cause not be removed, — by this 
we mean should the child continue to be subjected to the intense 
city heat and the same bottle-food, — diarrhoea will soon become 
excessive, evidences of inflammation will appear, — vomiting, 
intense thirst, and an extremely watery diarrhoea, tinged with 
green and containing minute specks of greenish matter ; result- 
ing finally in entire loss of control over the bowels: the child 
will gradually lose consciousness and die of exhaustion. 

True cholera infantum is not a very common disease, and 
what is ordinarily known as cholera infantum, such as we have 
described, is simply the aggravation of an ordinary simple 
diarrhoea which has been improperly treated at the commence- 
ment, either through ignorance or the force of circumstances. 
It is impossible for one to fully guard a child against the many 
causes that conspire to produce catarrhal affections ; change 
of pasture of the cow, change of milk, overheated rooms, and 
the effects of sudden changes of weather are often beyond 
control. But as soon as the first symptoms appear, the indi- 
cations for treatment are absolute. If the symptoms of 
digestive derangement are very mild, simply consisting of a 
furred tongue, eructation of sour milk, or the appearance of 
curds or slime in the stool without any actual diarrhoea, weaken- 
ing the bottle with a little more water, taking out the farina- 
ceous material that has probably been added to it, giving a 
tablespoonful of Murray's fluid magnesia, and allowing the child 
to drink, if it is thirsty, weak gum-arabic water or toast-water, 
will probably be all-sufficient ; but if the child has pain in 
addition to these symptoms, the treatment is different. In 
x 30* 



354 MOTHER AND CHILD. 

such cases stop the bottle-food at once, and when food is re- 
quired give the child a mixture consisting of a tablespoonful 
of cream, a tablespoonful of fresh milk, and two tablespoonfuls of 
lime-water. Be careful not to overload its stomach ; feed it at 
frequent intervals, very little at a time. If it is thirsty, allow 
it to drink of the gum-arabic water or toast-water. If the 
child is a year old or more, and especially if it be summer- 
time, when the thirst is very great milk should be omitted alto- 
gether from the diet, and barley-water — made by adding an 
ounce of barley, crushed, to a quart of water, boiled for twenty 
minutes and then strained — may be given with condensed 
milk, one part to twelve ; or to this can be added two table- 
spoonfuls of lime-water when the bottle is made up, and the 
child given, every two or three hours, as a drink, ten drops of 
whiskey in one ounce of water and one ounce of lime-water. 
The white of an egg dissolved in a tumblerful of warm water, 
to which is added a teaspoonful of glycerin and a dessert- 
spoonful of orange-flower water, should be kept in a cool place 
and given occasionally, as a drink, if the child is thirsty. To 
this may be added ten grains of lacto-peptine. 

In the cases just described the medicinal treatment would be 
to clear the bowel at once of the accumulated curds and mucus 
and relieve the congestion, and for this purpose a dose of 
castor oil may be given as follows : a teaspoonful of castor oil, 
ten drops of aromatic syrup of rhubarb, and a dessertspoonful 
of warm soda mint (solution). A warm foot-bath should be 
given, and over the child's abdomen should be placed either a 
mustard poultice (half flour), a spice poultice, or flannels wrung 
out in hot water, over which should be sprinkled some essence 
of ginger. After the oil has operated once, and a large mass 
of curds and mucus has been expelled from the bowels, the 
subsequent passages will be of a more natural color, but very 
cautiously indeed should the mother return to the ordinary 
bottle-food. If the weather is very warm, the child should 
be taken daily to some shady spot in the suburbs, where 
the air is purer and fresher than it is in the city. If pos- 



DIARRHCEA. 355 

sible, it should for several hours a day be permitted to breathe 
air that comes off the water. There is no city charity that 
should receive more encouragement than that which gives river 
or country excursions to poor children. A few moments' 
ride in a ferry-boat will often revive a child that is almost 
exhausted by the heat and is succumbing to summer-com- 
plaint. The nervous system has given out, it has • lost its 
control over the blood-vessels, and the serum or watery por- 
tion of the blood, that contains all the nourishment, leaks into 
the bowel and is drained away. The little sufferer dies abso- 
lutely of hemorrhage, — white hemorrhage. That is why these 
teething city babies so rapidly emaciate; that is why they 
crave water to supply that which is lost. A child, then, should 
be treated in such a way that its nervous system will be 
strengthened and once more given control. It should have 
fresh, pure air, — either the air from the country, or, better, 
the air from the water, or" better still, the air from the sea. 
Its tissues should be braced by stimulating, cooling applica- 
tions ; it should be sponged with vinegar and water, or alcohol 
and water; its feet should be soaked in water containing a 
little mustard, to stimulate its circulation ; the room should be 
kept as cool as possible, thoroughly aired, free from all con- 
tamination by sewer-air or putrefying matters, and the food 
given should be absolutely pure and untainted. 

In all these cases, if in the city, avoid raw milk, also 
starches of all kinds, even should they be thoroughly cooked. 
After a child has taken a dose of oil, it can be fed on con- 
densed or evaporated milk, and wine-whey may be given to it 
as a drink, a wineglassful every three or four hours, should 
it exhibit any symptoms of exhaustion. After the bowels 
have returned to their normal condition, the food can be 
changed to either Pasteurized milk prepared for the bottle, 
or some of the other preparations mentioned in the chapter 
on that subject. In these cases peptonized milk is often 
very valuable, and when a milk diet is returned to, it should 
consist of Pasteurized peptonized milk, — that is, milk sterilized 



356 MOTHER AND CHILD. 

at 155° F., and containing the necessary amount of Fairchild's 
"peptogenic milk powder." 

It is well for a mother to recognize the fact that her child 
should abstain entirely from food in these earlier stages of 
diarrhoea, especially in summer, certainly until her plrysician 
has seen the case. She should make it a rule to allow the 
child to drink freely, if it wishes it, of gum-arabic or toast- 
water ; give small pieces of cracked ice, wine-whey, Valentine's 
beef-extract or the fresh expressed beef-juice, or some chicken- 
broth; indeed, the beef-juice and chicken-broth, given with 
gum-arabic water, make a nutritious and harmless diet in all 
of these cases. This hygienic treatment alone, in the earlier 
stages of a diarrhoea, will be of very great advantage, and 
will materially aid the doctor by paving the way for that 
medical treatment which he may find necessary in order to 
bring about a normal condition. 

Of course, a diarrhoea may come on very suddenly, with 
great intensity, and may prove fatal within a few hours. These 
cases are called cholera infantum. Their suddenness is appall- 
ing ; their treatment should be immediate. Such cases seem to 
be caused by a union of all those conditions one of which alone 
is sufficient to produce diarrhoea ; it is a blood-poisoning, origi- 
nating, possibly, in the absorption of some germ, and aggravated 
by improper diet, lowered vitality on the part of the child, im- 
pure air, and intense heat, continuing unabated day and night. 
Cases may originate in this way, coming suddenly upon chil- 
dren who have been previously in good health, or this condi- 
tion may be the result of a protracted and neglected simple 
diarrhoea. The mother's duty in these cases is always to 
attend to the hygiene, and by hygiene we mean proper food, 
judicious bathing, and the placing of her child where it can, 
for at least a part of the day, breathe pure air. 

But the doctor's duties are equally important. Our object is 
not to instruct the mother how to take the doctor's place, — his 
duties are distinct from hers; but it is simply to give her an 
intelligent understanding of what the doctor means when he 



NURSING OF SICK CHILDREN. 357 

lays down certain rules which are to be carried out in the 
nursing and management of her child, and without attention 
to which the medical treatment would be absolutely of no avail. 
It would be ridiculous for the doctor to give a child morphine 
and sulphuric acid "for a severe case of cholera infantum, or 
salicylic acid or bismuth and pepsin, while at the same time 
the baby is kept in a close, ill-smelling room, and attempts are 
made to quench its thirst by the free administration of tainted 
cow's milk given through a dirty nursing-bottle ; and yet how 
often, even in families that should know better, do we find 
appalling ignorance in regard to these most important matters ! 
If the child vomits much, food by the mouth should be 
avoided and nutritious injections given instead, such as a raw 
egg beaten with warm water and five or ten drops of brandy 
or peptonized milk, about one ounce every two hours. 



CHAPTEE ILY. 

NURSING OF SICK CHILDREN. 

It is proposed in this section of our work to give to mothers 
and nurses a plain statement of the causes and method of nurs- 
ing of the more important disorders and diseases of children. 
By disorders we mean simply functional disturbances ; by dis- 
eases we mean those disturbances that are accompanied by some 
structural changes. 

It is not necessary to dwell at length upon the appearance 
of a sick child. We have endeavored to form a picture of a 
child in the enjoyment of perfect health, — an infant with all 
its functions working in perfect accord, whose sleep is soft and 
gentle, who awakes bright and cheerful, who eats with an evi- 
dent relish for food, and who becomes drowsy as digestion be- 
gins : one whose eyes are clear and bright, its skin soft, its 
flesh firm, bears evidences of health. But when the child be- 



358 MOTHER AND CHILD. 

comes peevish, restless, or drooping, uneasy after eating, start- 
ing in its sleep, when the eyes lose their brilliancy and become 
encircled with dark rings, its skin is hot and dry, and possibly 
the hands and feet cold, its flesh flabby and soft, and the 
rotundity of its form marked by a tendency to angularity, 
showing a loss of the cushions of fat, it does not require much 
experience to recognize such as a sick child. "Whether or not 
this deviation from health is simply functional, or due to dis- 
ease, is not the question we have to deal with ; that rests with 
the doctor; but as he depends on the mother for a true recital 
of those symptoms upon which he bases his conclusion, a 
habit of accuracy in observation, one of thoroughness in in- 
vestigation, should be cultivated by her. This and the thorough 
carrying out of all the details of treatment, not as a mere 
machine, but as an intelligent being, one who is capable of 
exercising judgment, form the essentials of a good nurse, and 
this every mother should seek to be. 

"Within the past ten years excellent training-schools for 
nurses have been instituted in most of our large cities, and 
the graduates are doing noble work. In most cases of serious 
illness in families who are able to bear the expense, a trained 
nurse is the doctor's most efficient adjutant, but in many, indeed 
by far the most, cases some member of the family has to be 
impressed for such a duty, and some knowledge of the subject 
of this chapter becomes a valuable aid. 

Miss Catherine Wood, of London, has written much upon 
this subject, and we will here quote at length from one of her 
valuable articles. 1 

" The sad experience of every doctor who has had to treat a 
spoiled child at home will confirm this : the child refuses to 
take its medicine or food, and the united efforts of the parents 
and household are useless ; it remains master of the situation 
a hardened little sinner. Or some particular posture must be 
maintained to allow an inflamed joint to recover itself; it 

1 Keating's Cyclopaedia of the Diseases of Children, vol. i. p. 347. 



NURSING OF SICK CHILDREN. 359 

screams and kicks at all efforts to place it aright, it frets if 
fastened down, and refuses its food, until at last it is allowed 
to lie as it likes, and valuable time is wasted. Place that same 
little one in a children's hospital, in the hands of doctors and 
nurses accustomed to children, and it at once becomes tracta- 
ble ; all friction and contests are avoided ; it follows the ex- 
ample of the next cot, and swallows medicine and food .quietly ; 
it submits to be laid down, for it seems the fashion of this 
nursery and so must be right. Then the atmosphere of play 
and merriment carries it over the tedious hours of a chronic 
illness almost unnoticed. Dr. West, who was certainly the 
pioneer in initiating a specialty in the treatment of sick chil- 
dren, says in his opening lecture to students, ' Children will 
form at least one-third of all your patients ; so serious are 
their diseases that one child in five dies within a year after 
birth, and one in three before the completion of the fifth year. 
These facts, indeed, afford conclusive arguments for enforcing 
on you the importance of closely watching every attack of 
illness that may invade the body while it is so frail' . . . She 
[the nurse] must also learn how to combine firmness with 
gentleness, how to insist without coercion, how to win obedi- 
ence without friction, how to take her patient along with her ; 
and all this can be accomplished only by love and truthfulness. 
Once win the child's trust, and then it will yield itself a willing 
slave. The most fearless truthfulness should be insisted on 
from all those who have to tend the sick child, even when it 
wrings the loving heart to speak the truth. The pain the child 
will feel will be far less than upon finding itself deceived, 
especially when among strangers. . . . 

" The poor mothers in their own homes make quite a toil of 
their children ; they will hardly put them out of their arms, 
and they certainly will not believe that the child can be thriv- 
ing unless they are dandling it on their knees ; both are quite 
wearied, mother and child. But this is all mistaken kindness. 
A sick child will thrive best if laid quietly in its own cot, so 
that the fresh air may play around it, and that it may rest. 



360 MOTHER AND CHILD. 

Its little face will soon lose the worried look that is so often 
marked on the faces of the children of the poor, and a look 
of happiness and content will take its place. It is not difficult 
to accustom the children to lie quiet; at first they will be 
restless and fret at not being taken up, but when they see 
that their frettings are of no avail, with the ready adaptability 
of childhood they make the best of it, and soon find how much 
the best it is. 

" It is most essential in the care of sick children that they 
should be supplied with plenty of light and fresh air, in neither 
case pouring in directly on them, but flooding them all round 
in generous profusion. They by no means appreciate the 
darkened room and hushed voice: like the plants in the 
garden, they expand under the rays of light ; and there can 
be no doubt that the light has a physiological influence on 
their growth and development, especially so in the case of 
illness. Therefore in arranging the sick-room, let it have as 
much of the light as possible, a southern or western aspect, 
and a free circulation of air through it, by maintaining an in- 
terchange with the outer air without making a draught ; and 
this should be kept up by night as well as by day, especially 
in crowded cities. Of course in certain fever cases, in acute 
diseases of the brain or diseases of the eye, a darkened room 
may be required. 

" The sympathetic nature of the child is at once affected by 
any deviation from the standard of health ; its organism is 
like a delicate machine, disturbed by the presence of a minute 
grain of sand ; it at once gives token that there is some morbific 
influence at work. The severe onset of an illness, its rapid 
course, and its speedy termination either in recovery or death, 
are always matters of surprise to those accustomed to sick 
children ; and so it requires that the attendants should be 
fully on the alert to catch each new symptom, give it its value, 
and be prepared with appropriate treatment. It is hardly a 
safe course for the mother to wait until her child's illness has 
declared itself before she takes action ; and even then, as a 



NURSING OF*SICK CHILDREN. 361 

mild domestic ailment and an acute disease may alike assume 
the same symptoms, she would act more wisely to seek some 
skilled assistance, for, however experienced a mother may be, 
she can hardly read symptoms aright. Or it may be that one 
of the infantile infectious complaints is declaring itself; and 
then for the sake of the other children some system of isola- 
tion is necessary. 

" Illness at first shows itself in a child by listlessness and loss 
of appetite ; the eyes look heavy ; the child may be fretful, 
especially if disturbed, or it may be drowsy ; it will feel hot, 
and if the temperature be taken the thermometer will gener- 
ally show an elevation above the normal; but this in itself 
must not be regarded with disquiet, as a very little suffices to 
disturb the normal heat of the body ; in nearly all cases there 
will be vomiting and some bowel-disturbance, and then special 
symptoms will declare themselves. In the older child, one 
able to give some account of itself, the symptoms generally 
set in in the same sequence, and they must be taken as a warn- 
ing that something is amiss. The best treatment is to wait 
and see what is coming, at the same time placing the child in 
favorable circumstances, — that is, keeping it quiet and away 
from its fellows, giving it light food, of easy digestion, seeing 
that the bowels are not overloaded, and then waiting for the 
diagnosis of the medical attendant. 

"Age has much influence upon the diseases of children, and 
if it is borne in mind that before the age of seven the body is 
being built up rapidly, and this means a great expenditure of 
vital force, it is more easily understood that a small disturbing 
cause will seriously upset the equilibrium of its powers. It is 
of more importance to keep a child in health than to restore 
it from illness to its normal condition ; and yery much may be 
done by regularity in all its habits. Appropriate food at 
regular intervals will drill the digestive apparatus into strong, 
healthy ways; regular hours of rest and exercise will soothe 
and strengthen the nerve-centres ; the muscular powers will 
be developed by use, and the mental faculties develop them- 
q 31 



362 MOTHER AND CHILD. 

selves in harmony with the animal vigor. There are certain 
crises in the child's life that must always be reckoned with as 
causes of disturbance, — notably, the period of teething. This 
is a sea of troubled waves, over which the little bark must be 
sensibly steered and it will voyage in safety ; but then it is a 
natural process, for which provision has been made in the 
child's constitution, and if its surroundings and habits are 
healthful it will pass over the storm with but little danger. 
Of more serious moment are the hereditary defects that are 
ever-present dangers to the child life and will break out into 
flame with the least spark and will modify acute disease by 
their influence. If the mother has a good knowledge of her 
child's constitution, she may do much to defend the weak point 
by engendering a wholesome habit of living. This much is 
quite certain, that no two children are alike, and that they 
will thrive the best who receive the most individual thought. 

" Of secondary importance, but by no means to be forgotten, 
is the child's nursery : here three-fourths of its day will be 
spent, and its aspect and traditions will never die out of the 
child's life. It is of paramount importance that it should be 
bright, cheerful, clean, and wholesome, that its presiding genius 
should be a lovable, common-sense woman, and that order and 
method should rule its habits. The little ones will then look 
back upon their nursery days as some of the brightest in their 
life. 

" It may become the sad necessity to turn this bright room 
into a sick-ward. In such case, turn all the unnecessary articles 
of furniture out of the room, take up the carpet, remove the 
hangings, if there are any, and have at hand everything that 
is likely to be wanted, extra basins, jugs, cups, and feeders, 
small pans for the linen, a plentiful supply of water and 
liberal means of making it hot, baths, and a ready supply of 
linen. Keep all these appliances handy, but outside the room, 
and also outside have vessels for receiving the slops, so that 
nothing offensive may be about the patient. Provide a good 
supply of some disinfectant in a concentrated form, to be 



NURSING OF SICK CHILDREN. 363 

readily weakened, and let this be freely used on the floor, in 
the vessels, and for soaking the linen from the patient. Last, 
but of no less importance, is the choice of the sick child's 
nurse. It does not follow that either the mother or the nurse 
is the most fitting"; the one may be too nervous and excitable, 
the other too indulgent or ignorant: what is wanted is a 
steady, reliable woman, who can manage the patient with 
kindness and firmness, who can be trusted to carry out orders 
and yet have a discretion of her own, cheerful and even-tem- 
pered, physically strong in the face of an extra demand on 
her powers, cool and self-possessed in an emergency, and, above 
all, with a love for her work and her patient. If added to 
these qualifications there is hospital training, then the right 
attendant is found. It is very essential that as far as possible 
the management of the sick-room should be kept in the hands 
of one person, so that there may be a unity of treatment and 
that methodical harmony which is of more importance in sick- 
ness than in health ; and then, if the assistants are obedient, 
good work may be done. There are few things more harmful 
than the fidgety nursing that one so often sees in the family. 
The nurse, if she shows herself to be a woman of tact and 
sympathy; will soon infuse her spirit into the members of the 
family, and they will readily work under her guidance. 

" There are many little niceties of method and order that 
form part of the training of a nurse in the hospital wards, 
that will add to the comfort of the patient. A child with any 
form of joint- disease or fever is easily washed in the recum- 
bent position on a blanket, being rolled gently from side to 
side, and in the case of an injured limb it must be steadied 
with one hand or by a second person, and then there is very 
little pain or displacement. It is a great husbanding of the 
strength in fever, especially typhoid, to keep the patient 
always lying down, and the whole of the person can be prop- 
erly washed in this way. This is the sovereign preventive of 
bed-sore, especially in cases of paralysis, where the evacuations 
are not retained, and enables the nurse to see at once any 



361 MOTHER AND CHILD. 

weakness of the skin. Complete drying of the skin must be 
insisted on, and the liberal use of dusting-powder, and then a 
child may lie for months on its back without any ill effects. 
An important part of the nurse's work is to prepare her 
patient for a physical examination, and to do this quickly and 
readily without undue exposure is a sign of good training. 
It is very irritating to a doctor to watch a nurse fumbling at 
buttons and strings, and it wearies the child. Before the time 
of the doctor's visit she should have all the clothing loosened, 
and a blanket warming at the stove to wrap the child in if it 
is to be taken out of bed. If the child is to be examined in 
bed, the night-gown and vest are drawn over the head and 
placed on the stove to keep warm : this is a little detail, but it 
is important for a delicate child to be saved the chill of cold 
garments when exhausted by the examination. A loose wrap 
will serve to cover the parts not under observation ; and if the 
doctor uses the towel whilst examining the chest, be sure that 
it is one well aired. If the patient is removed from the bed, 
the nurse will take the child in the warmed blanket on her 
lap and be ready to adjust it to the doctor's needs. Some 
little gentleness and coaxing are required to prevent the child 
from being frightened, and a few moments of time must be 
spent in winning the patient's confidence and allaying its 
fears ; and if this is successfully accomplished, the patient 
will probably look upon the whole as a game for its amuse- 
ment. Should some operation be necessary without an anses- 
thetic, it is far better to tell the child that it will be hurt a 
little bit, and if the instrument be kept out of sight the fright 
will be very momentary. It is marvellous how patiently 
children submit to painful remedies if only they are treated 
with candor. In putting on hot applications it must be borne 
in mind that the child's skin is more sensitive and tender than 
an adult's, and that the test of the nurse's hand is not sufficient ; 
the child's sensations must be the guide. It is a cruel thing 
to put on a fomentation or poultice too hot, and it does no 
good if it excites the child. If a blister is ordered, it can be 



NURSING OF SICK CHILDREN. 365 

put on more efficiently with blistering fluid, care being taken 
that it does not run, and if put on at night the child will gen- 
erally sleep through it; the after-treatment will be according 
to the instructions of the medical attendant. Children are very 
tolerant of blisters, and in wise hands they are useful reme- 
dies. The application of leeches is more complicated : the 
sight of them must frighten the child, so they should be dealt 
with quickly and decidedly. The easiest way is to turn the 
box on to the part, which should be first well washed, and 
then wait until they have all taken ; or take them up in cot- 
ton-wool in the mass and hold them on; in either way the 
child does not see them moving about, and if the cotton- wool 
is left on they will not be very evident. They must be left 
until they drop off, and then the part washed, pads of lint or 
absorbent wool put on, and the whole bandaged up. The 
nurse must be on the watch for after-bleeding and report to 
the doctor. 

" Leeches should not be placed on the prominence over a 
bone, nor on a vein, nor on any part that receives pressure. 
The pain is not severe, and the fright is caused more by the 
sight of them than by their bite. If possible, the child should 
be kept quiet after the application, or the bleeding may be- 
come troublesome. 

" A very frequent remedy ordered is an enema, either as a 
medicine in diarrhoea or constipation, or as a means of giving 
food. Its nature and quantity will be prescribed by the doc- 
tor, but its administration will be in the hands of the nurse. 
Supposing it is to check diarrhoea, it will probably consist of 
starch and opium, and should be made as small in bulk as pos- 
sible, — not more than two or four teaspoonfuls of mucilage 
with the quantity of opium prescribed ; if to deal with con- 
stipation, it will be large in quantity, such as a pint of soapy 
water warm, or gruel and castor oil, or soap and castor oil ; 
and after the injection has been given leave the patient quiet 
until there is a desire to return it. The tube should be well 
oiled and passed up the rectum gently as far as it will go. In 

31* 



366 MOTHER AND CHILD. 

giving nutrient enemata, the food must be made as concentrated 
as possible, and be a little thickened with starch powder or 
arrow-root. Four ounces is as much as the bowel will retain 
with advantage. 

" A nurse who knows her work will know that she has to put 
out the urine for testing by the doctor : it should be a small 
quantity taken from the first passed in the morning, and let 
it be put aside in a clean vessel and covered over. 

" It may be that she is instructed to measure and record the 
amount of urine passed in the twenty -four hours : in such 
case she must have a suitable vessel, such as a marked jug or 
glass, provided for her, and then should begin her observations 
thus. Let her fix on an hour, say nine a.m., at which to take 
the observation : on the first morning let the child pass water 
at that hour, and then throw it away : all the water passed 
subsequently is to be saved, and at nine a.m. the next morning 
the child is to be invited to pass water, and then the whole 
quantity is measured, recorded, and thrown away. If the 
specific gravity is to be taken, the nurse must be shown how 
to use the little instrument that weighs it, and how to record it. 

" It is also part of the nurse's duty to examine the evacuations 
and report on them, and in any case of doubt to save them for 
inspection. On this point there is a great deal of ignorance 
and diversity of opinion : one nurse will call that diarrhoea 
which another nurse will name only l a little looseness,' and 
so on. The presence of slime and blood in the evacuations 
should be at once reported, and the stool saved for inspection ; 
also the presence of undigested food. The frequency of the 
action and the quantity must likewise be observed, and intelli- 
gent answers given to the doctor's questions. 

" The diseases of young children are so frequently induced 
by bad management that the medical attendant will rely very 
much for the success of his remedies upon the intelligence and 
good management of the nurse. He may lay down theoreti- 
cal rules for feeding and rest which may be entirely upset by 
the wilfulness of his patient. What is to be done with a child 



NURSING OF SICK CHILDREN. 367 

who will not take milk, where that is the special diet indicated 
by its complaint? What is to be done with a child who will 
sleep by clay and feed by night ? Or with one who refuses all 
food ? In diarrhcea and vomiting, the administration of food 
has much to do with the recovery : first of all it must be 
suitable, then it must be given in such quantities as will suit 
the digestion, then it must be given regularly and with 
patience, and it must be freshly prepared. All the vessels 
used for it should be scrupulously clean, for the least trace of 
decomposition will upset the stomach. 

" The popular feeding-bottle with the india-rubber tube is a 
great offender : it is almost impossible to prevent particles of 
food from clinging to its inner surface, and as these decompose 
they will taint the most carefully prepared food. The bottle 
and nipple need careful scalding and rinsing, and should be 
kept in cold water betweentimes. If an infant hand-fed is 
troubled with diarrhcea and vomiting, look to the bottle first. 
As a subsidiary measure, and one of some importance,- see that 
the loins and the abdomen are quite warmly clothed. In feed- 
ing a child who has a delicate or irritable stomach it is of 
great importance to give the food in small quantities and as 
frequently as the digestion will bear. 

" In all diseases of the respiratory organs the child requires a 
warm, even temperature, not made stuffy or poisonous by 
want of efficient ventilation, but a constant temperature kept 
up with a free interchange of fresh air. This requires a little 
management, but it can be done. What is essential is that 
the external air, which is the freshest, should be admitted 
steadily, and the temperature kept from falling below 60° F. 
The means by which this is to be brought about must be left 
to the nurse's ingenuity, but she must remember that letting 
in the used-up air off the staircase and passages is not venti- 
lating with fresh air. 

" At times it is a great relief to the patient to moisten the 
air with steam ; this is best done by surrounding the bed with 
some light curtains or screen and then letting the steam come 



368 MOTHER AND CHILD. 

into the bed from some suitable apparatus, care being taken 
that there is an escape from the top of the bed, or the curtains 
will become damp. This is an essential in the treatment of 
laryngitis and diphtheria after the oj)eration of tracheotomy, 
it being advisable to moisten and warm the air before it enters 
immediately into the lungs through the tube. 

" It will not be necessary in an article of this nature to give 
instructions for dealing with diphtheria or laryngitis, as these 
cases require incessant care on the part of both medical attend- 
ant and nurse. Still, a few hints of arrangement may be of 
use. There are few cases that demand more skilled nursing 
than diphtheria, and the attendance on such cases should be 
always put into the hands of old, experienced nurses, especially 
after the operation of tracheotomy, as careful feeding and 
watching by an experienced nurse are essential to recovery. 
One small precaution, may prevent the nurse from taking a 
disease which is propagated by the breath, and that is to keep 
her mouth closed whilst standing over the patient, and to use 
a disinfectant for washing the hands before taking her meals. 
A basin of weak carbolic solution should be put near the cot 
for washing the sponges, etc., used about the patient, and all 
feeding-cups, spoons, and glasses must be kept apart. Linen 
over a piece of waterproof to make a bib and pinned over the 
neck of the child's night-dress is a clean way of keeping the 
neck dry and wholesome ; for it must be remembered that the 
diphtheritic discharges are most irritating to the skin. To 
sum up, a nurse in dealing with these cases must be prepared 
for a work that will tax all her skill, patience, and vigilance : 
her patient will require incessant watching, and will make 
endless demands on her ingenuity. Instead of pocket-hand- 
kerchiefs, some rags that can be burnt at once are advisable. 

" When infectious diseases are in the house, very much may 
be done by way of precaution in the use of disinfectants for 
the linen and the discharges before they are taken out of the 
room, as it is in these that the germs of disease are conveyed. 
A sheet kept moistened with some disinfectant, and hung over 



NURSING OF SICK CHILDREN. 369 

the outside of the door of the sick-room, is very effective. 
Then, of course, there should be no intercourse between the 
inhabitants of the sick-room and the rest of the household, 
and the nurse and friends should change their garments before 
going out. The floor of the sick-room should be swept with 
saw-dust moistened in the disinfectant, and all dust and refuse 
should, if possible, be burnt. In scarlet fever in the- desqua- 
mating stage, it is the practice of some doctors to have the 
patient rubbed over with an ointment ; but, whatever treat- 
ment is adopted, it is essential that the skin be kept clean by 
frequent sponging with warm water, and by baths, and that 
the patient be kept warm in bed until the process is over. 
Every precaution should be taken to hinder the dust from the 
bed or room from being scattered about. 

" Measles is a much more unruly disease to deal with ; it 
starts infection in the early stage, before the eruption has de- 
clared itself, and so spreads among a household almost un- 
checked. The same rules of disinfection will apply to this; it 
is of importance to keep the patient in a warm room, in bed, 
until the eruption has quite disappeared, and longer still if 
there is any tendency to lung-disease, as shown by a continued 
high temperature and the state of the breathing. 

" In this and in all other eruptive diseases the diet should 
be light and nourishing and with but little animal broth or 
tea in it, as this is apt to be over-stimulating, except when 
contra-indicated by great prostration. Careful observation of 
the temperature is of great assistance to the nurse. It begins 
to fall about the third day ; but if it persists high or rises 
above 103°, then the nurse must be on the alert for some com- 
plications and look out for all symptoms that may aid the 
doctor in detecting the mischief, and for her part she must 
keep her patient warm, lying down, pay attention to the evac- 
uations, and support the strength with careful systematic 
feeding. 

" Whatever may be the nature of the illness, one great essen- 
tial in its nursing is scrupulous cleanliness in the person of the 
y 



370 MOTHER AND CHILD. 

patient and in all its surroundings. A sick child should be 
washed all over every day, and sometimes twice a day; every 
part of its body should be examined, that the first sign of a 
sore maybe detected, or any change in its condition, such as a 
swelling, discoloration, or enlargement about a joint, and such 
information should be handed over to the doctor at the earliest 
opportunity. In the case of young babies, their skin requires 
washing and drying each time the napkin is changed ; a nurse 
who knows her work well will be able to keep her charges 
clean and their wants anticipated without giving in to these 
lazy ways. If the patient is to be clean, so must also the bed, 
and all soiled linen at once be taken away, not pushed under 
the bed out of sight, nor one wet end of the sheet tucked 
under the mattress, but absolutely put in its proper receptacle, 
where it will do no harm. The hospital draw-sheet is very 
useful on the sick-bed ; it can be quickly drawn away without 
much disturbance to the patient, and another substituted. A 
draw-sheet is a narrow, long sheet, about one and one-half 
yards long by three- fourths of a yard w T ide, of a coarser mate- 
rial than the linen, and is placed under the body of the patient, 
sometimes with a square of mackintosh under it ; it tucks in 
well and. keeps things straight. . . . 

"Some children dread the water: the origin of this fear 
is very often caused by roughness in washing them, or by 
hustling them too suddenly into a bath. Eickety children 
are essentially tender to the touch, and they require gentle 
handling when in the bath. 

"As the bath is essential for both the healthy and the sick 
child, the nurse must use her ingenuity to overcome the fear. 
An ordinary warm bath should be of the temperature of 98° 
F., and this should be decided by the use of a thermometer 
and not by the nurse's hand. Let the child be quite ready for 
the bath when the bath is ready for the child, or it will be 
cooling. When the bath is over, have at hand a warmed 
blanket on which to place the child whilst being dried ; let 
the drying be done quickly and the child be put into its 



NURSING OF SICK CHILDREN. 371 

warmed garments for bed. If a douche-bath is ordered and 
the regular appliances are not handy, place the child in an 
ordinary warm bath, standing if possible, and then pour a jug 
of cool water down the spine from a height, or on to that par- 
ticular part for which the douche is ordered. Eub the part 
well with a rough towel, so as to get up good circulation, and 
knead it with the hand. If a bath is ordered to reduce the 
temperature, its temperature should be 65° F. The bath being 
brought to the bedside, the patient is lowered in on a blanket 
and kept in five or ten minutes, according to the doctor's orders ; 
then the patient is dried quickly and put back to bed. . . . 

"It is an essential in the clothing of a sick child that it 
should be loose, light, easily changed, and sufficient. A sick 
child does not make the same use of its bedclothes that the 
sick adult does, and so some warm jacket must be put on to 
keep its chest and shoulders protected. The bedclothes also 
must be light and warm, and not doubled in a heavy fold over 
the chest, perhaps already overweighted with some difficulty 
in breathing. 

".When the patient first gets up it is necessary that the 
surface of the body be thoroughly well covered with light 
warm clothing, put on quite loosely. Woollen clothing is 
more warmth-giving than cotton, and is lighter. Neither in 
sickness nor in health should the child's body be confined in 
stiff clothing; binders and stays of all kinds are a mistake; 
they interfere with the free use of the muscles, and do not 
improve the shape. In construction also the clothing should 
be simple and easily put on and off. It would not be advisable 
in this chapter to advise any patterns or styles for the chil- 
dren's dress ; but, laying down these rules as above, feminine 
ingenuity may easily devise a shapely garment that will har- 
monize with them and with the child's requirements. In 
sickness, the flannel vest and bed-gown require frequent 
changing; and it is a great soother of the night's rest to 
change the garments entirely at the child's usual bedtime. 
In dealing with surgical cases which must be kept in one 



372 MOTHER AND CHILD. 

position, it facilitates the process to have a night-gown open 
down its whole length; the same applies to patients with 
typhoid fever. . . . 

" In preparing a bed for an operation, or where the patient 
must remain on it for a long time, a firm hair mattress should 
be selected, and a continuous board placed under it, two sheets 
folded straight down the centre, so that they can be easily 
withdrawn and kept in their places with a draw-sheet, and 
then the rest of the clothing arranged so as to give the most 
warmth. All creases must be carefully avoided, as they will 
cause a sore ; and if pillows are required to support a limb, 
they should be firm, like sand pillows, and as small as possible. 
A good feather pillow is often of use for slinging a limb ; but 
every appliance must be adjusted to the restlessness of child- 
hood and to the tender nature of its skin. It is wonderful 
how tolerant children are of one posture and of long confine- 
ment in bed, if only they are placed in a comfortable position 
and well amused ; and they will maintain an ordinary standard 
of health under such circumstances, if fed sensibly. 

" It may strike the reader that many of these details are 
needlessly minute ; but it is by attention to such minutiae that 
the work of nursing a sick child back to health may be accom- 
plished. Nothing is too small that contributes to such an ob- 
ject, and those who have had much experience in the care of 
sick children know that all their success will depend upon care- 
ful thought for these details. 

" There can be no doubt that it is very hard work to nurse 
a sick child; but there also can be no doubt that the hard 
work amply repays itself in its results." 

All medicine should be kept out of a child's reach ; indeed, it 
is always well to have a small medicine-chest under lock and 
key. 

A mother or nurse should make it a rule always to read the 
directions on the bottle before administering any medicine. Mis- 
takes frequently occur, especially during periods of excite- 
ment, and the wrong medicine administered. 



NURSING OF SICK CHILDREN. 373 

In concluding this chapter, we will quote from an article 1 by 
Dr. Byers, of Charlotte, North Carolina, on disinfection. The 
greatest attention to detail is necessary to prevent the spread 
of contagion from the sick-room, and as many of the acute 
affections of infancy and childhood are due to contagious disease, 
this matter assumes an additional interest and importance. 

" In each particular disease there is always some peculiar 
or special portion of the body involved which is occupied by 
and reproduces the exciting causes of infection. It is to 
these parts that we must always first direct our attention 
when beginning to disinfect for the disease. Fortunately for 
prophylaxis, the exact location of the centres for breeding is 
known in quite a number of diseases, and we can attack these 
seats directly. In all the exanthemata this is the case, and in 
them it is the skin and the mucous membranes which should 
receive the most attention ; while in typhoid fever and cholera 
it is the discharge from the bowels, and possibly from the kid- 
neys also, which we must particularly attend to. 

' ; For personal disinfection, Labarraque's solution, diluted 
with twenty parts of water, is suitable for washing and bathing 
the body. A weak carbolic solution, or a one-per-cent. solution 
of chloride of lime, will also be found efficient for the same 
purposes. Oily disinfectant inunction for the skin is one of 
the best methods of preventing the detachment of epithelia 
and pus, and should be used from the commencement of 
measles, small-pox, scarlet fever, and chicken-pox. It is found 
better and more agreeable when mixed with camphorated olive 
oil or with carbolic acid and olive oil. The throat and fauces 
in these diseases should also be washed with Condy's fluid, or a 
weak solution of sulphurous acid. All discharges from the 
nose, eyes, and mouth should be received upon rags and imme- 
diately burned, or, if upon towels and handkerchiefs, these 
should be put in a solution of chloride of lime. The stools 
should be disinfected by a solution of bichloride of mercury, 



1 Keating 's Cyclopaedia of the Diseases of Children, vol. iv. 
32 



374 MOTHER AND CHILD. 

one-half ounce to the gallon of water, and all clothing treated 
by placing it in boiling water to which have been added two 
ounces of chloride of lime for each gallon. With regard to 
the disinfection of the apartments, furniture, and hangings, an 
observance of the directions in the general remarks that are to 
follow will be amply sufficient for all purposes. 

" Heat. — Extremes of temperature have long been known to 
be disastrous to animal and vegetable life, and are doubtless 
among the most efficient and satisfactory agencies that can be 
employed for disinfection. Of course it is not necessary to 
say that fire will destroy the principles of infection, since it is 
complete combustion. Heat in particular has a powerful and 
constant effect upon all albuminoid substances, both in coagu- 
lating and in desiccating. It is undoubtedly the best means 
of disinfecting bulky material, such as bedding, curtains, and 
clothing, and, if they be properly exposed to its action, all the 
contained life or contagion will certainly be destroyed. Heat 
is employed as a disinfectant in several ways, among which 
may be mentioned dry, moist or boiling, and steam heat. Drs. 
Parsons and Klein have made numerous and elaborate experi- 
ments both on the degrees of heat and on the time necessary 
for disinfection. The results of their investigation show that 
dry heat is best adapted to the usual purposes of disinfection. 
Ordinarily this kind of heat can be supplied by a common 
laundry drying-closet or a baker's oven, and will be sufficiently 
powerful to destroy all contagion unaccompanied by spores. 
Dry heat has one principal objection, however : it penetrates 
bulky and badly-conducting substances very slowly, and the 
time usually allotted for the destruction of germs is far too 
short for it to be effective. Hence if the drying-closet or oven 
be used the articles should remain in it at least four hours, and 
the temperature should not be below 200° or 225° F.,the latter 
being much better. With respect to the amount of heat that 
can be borne by ordinary fabrics, scorching is said to occur at 
different temperatures in different materials. White woollens 
are always soonest affected, and should be carefully watched. 



NURSING OF SICK CHILDREN. 375 

To avoid these bad effects in them, the temperature should 
never exceed 250° F. ; and even this may in a majority of 
cases be too much for the finest woollens. Dry heat is gen- 
erally applicable to all that class of goods which can be boiled, 
and is said to be materially aided in penetration by the addi- 
tion of a certain amount of moisture, though the moisture is 
of no assistance in facilitating the destruction of the germs. 

" Dr. Henry has been successful in destroying the infective 
principle of scarlet fever, contained in clothing, by means of 
a dry heat of only 140° F. kept up for three hours. Most 
authorities, however, recommend a temperature of at least 
225° F. for all kinds of exanthematous disease, such as small- 
pox, measles, chicken-pox, and the like. . . . 

" Koch has found that bacteria in general, free from spores, 
cannot resist a temperature of 212° F. for many minutes, and 
that if it is continued for an hour and a half they invariably 
perish. 

" As to the action and results of moist heat or boiling as a 
disinfectant, experiences are not very satisfactory. Still, if the 
boiling be kept up for several hours, and a little carbolic acid, 
or chloride of lime or of zinc, be added to the water, the results 
can be relied on as effective. Should there be any doubt about 
the destruction of the germ when lodged in clothing or other 
articles of similar character, we should not hesitate, to employ 
the highest dry heat compatible with the safety of the goods. 
The finest fabrics will withstand for a reasonable time an ele- 
vation of 225° F., and linens, cottons, and woollens may be 
trusted to it without the apprehension of any injury or danger. 
Two hours of dry heat such as has been described will be amply 
sufficient, and no evil consequence will follow either to the 
safety of the goods or in the form of disease. 

" Steam is considered to be a rapid and powerful disinfectant, 
experience showing pretty conclusively that at 212° F. it will de- 
stroy all contagion, and the complete penetration by steam for 
five minutes is found capable of thoroughly disinfecting. . . . 
Steam penetrates far more rapidly than dry heat, and is much 



376 MOTHER AND CHILD. 

more destructive, in the time occupied, to all germs. A press- 
ure of twenty -five pounds is said to assist materially in its 
destructive action. 

" Chemical Disinfectants. — These are employed in the form 
of gases, liquids, and solids. 

" Gaseous substances are employed principally for aerial 
fumigation, and are applicable for the disinfection of apart- 
ments, etc. I shall not undertake to enumerate the various 
articles of this class that have been used from time to time, 
but shall simply confine myself to a description of a few of the 
leading ones, such as experience demonstrates to be effective. 

" A number of chemical substances are known to evolve 
oxygen very freely when brought in contact with organic 
bases, and in this manner disintegration of the obnoxious mat- 
ters is presumed to take place. Chlorine, bromine, nitrous 
fumes, and ferric compounds are supposed to disinfect to some 
degree by this method. With respect to the chemical reactions 
that take place in the use of the other substances which will 
be mentioned farther on, very little appears to be known. 

" Fumes of Sulphur — Sulphur Dioxide. — The most available, 
inexpensive, and reliable disinfectant that can be employed for 
fumigating apartments and preventing the spread of exan- 
thematous diseases is sulphur dioxide, (S0 2 ). The Greeks and 
Bomans were acquainted with the preservative properties of 
this gas, and used it as an antifermentative in wine. It is two 
and a quarter times as heavy as air, and is usually generated 
by burning sulphur. It has a peculiarly pungent and dis- 
agreeable odor, which is perceived when a sulphur match is 
ignited. Guyton de Morveau, who first studied its action, was 
of the opinion that it would completely disinfect miasms. Its 
chemical action is supposed to be due to its power to deoxidize 
the resultant acid coagulating albuminous matter. For the 
disinfection of rooms recently vacated by diseased persons, 
three pounds of sulphur should be burned for each thousand 
cubic feet of air space. The sulphur can best be ignited by 
pouring over it two or three ounces of alcohol and applying a 



NURSING OF SICK CHILDREN. 377 

lighted match. The room during the entire period of fumi- 
gation should be kept completely closed, and about twenty- 
four hours afterwards opened and thorough ventilation allowed. 
Before using this agent, however, all carpets should be taken 
up, the wall-paper removed and burned, the hangings thor- 
oughly loosened, and every part exposed so that the gas can 
penetrate everywhere. . . . Sulphurous acid and sulphur di- 
oxide are both destroyed by chlorine and permanganate of 
potassium, and should never be used in conjunction with either. 
The great solubility of sulphurous acid renders it one of the 
most valuable substances with which to disinfect liquids. Dr. 
Edson, of the New York Board of Health, in a recent' report, 
says that sulphur dioxide is the most practicable and reliable 
means that he has ever seen employed for the disinfection of 
the exanthemata and diphtheria. 

" Glilorine. — This is a pale yellowish-green gas at ordinary 
temperatures, about two and a half times as heavy as ordinary 
air. It is a powerful oxidizing agent, and extremely irritating 
to the air-passages when inhaled. It decomposes ammonia 
and sulphuretted hydrogen, and affects all compounds arising 
from the putrefaction of organic matter. It is commonly 
used for the same purpose as sulphur dioxide, and, like that 
agent, renders the occupation of the apartments temporarily 
impossible. It bleaches organic matters and destroys odors, 
either by withdrawing hydrogen or by direct oxidation. 
Chlorine is usually generated by means of chloride of lime, 
moistened either with water or with dilute sulphurous acid. 
There are several popular disinfectants which contain this gas 
in sufficient proportions to be of service : among these may be 
mentioned Piatt's chlorides, Labarraque's solution, and Javelle 
water. Chloride of lime is often used without the addition of 
an acid, being scattered as a powder in vaults, privies, and 
gutters. . . . 

" Fumigation should always be regarded in the light of an 
accessory, and should be, when practicable, accompanied by the 
processes of baking, steaming, and washing. All the wood- 

32* 



378 MOTHER AND CHILD. 

work — walls, floors, and furniture — must be rubbed down and 
washed with a solution of carbolic acid, one pint to the gallon 
of water, or a solution of bichloride of mercury, an ounce to 
the gallon of water, and the clothing and bedding baked, or 
washed in a solution of chloride of lime. A failure to make 
these processes complete by leaving a single place or article 
overlooked will create a new centre for infection, and all the 
work will have been in vain. 

" Carbolic Acid. — An important advance was made in disin- 
fectants when the virtues of this substance were discovered 
and brought forward. The great advantage of it, as a liquid, 
is that' it is slightly volatile, and therefore capable of being 
sprinkled in apartments and upon substances where it will 
penetrate every corner and crevice and be of service. It 
requires about twenty-five parts of water for thorough solution, 
and in this proportion is a powerful disinfecting liquid against 
all contagion. It coagulates albumen in the proportion given, 
and enters readily into union with organic substances wherever 
it meets them. ... Its chief property and that of the com. 
pounds associated with it is the power of destroying vegetable 
and animal organisms, and preventing putrefaction and fer- 
mentation in them. 

" Bichloride of mercury [corrosive sublimate'] in solution is the 
most powerful and remarkable disinfectant known to science. 
Investigation shows that it is a deadly poison to all the lesser 
forms of life, which it kills instantly when emploj^ed in proper 
quantities. It cannot be used in connection with lead, tin, or 
copper, owing to its corroding qualities. Its power to destroy 
germs, even in dilute solution, is unique. In the proportion 
of one to five hundred it destroys vitality in ten seconds, in 
one to two thousand in one and one-third minutes, and in one 
to twenty thousand in from fifteen to twenty minutes. Thus 
it will be seen that time is an element always to be considered 
when the solutions are used in ordinary proportions. 

" The fact that corrosive sublimate combines with albumen 
leads to the conclusion that it interferes somewhat with the 



NURSING OF SICK CHILDREN. 379 

process of destruction, and this is always to be remembered 
when using it as a disinfectant. 

" The following solution is recommended by Sternberg as 
quite capable of killing all the germs of infectious diseases : 
bichloride of mercury, four ounces ; sulphate of copper, one 
pound ; water, one gallon. 

" Dr. Parsons recommends the following solution as suitable 
for clothing, excreta, etc. : bichloride of mercury, half an ounce ; 
hydrochloric acid, one ounce ; aniline blue, five grains ; water, 
five gallons. Mix. This is the standard Solution !S r o. 1 of the 
Public Health Association, and has been tested thoroughly. It 
should be labelled '-poison' 

" Sewage. — A large number of substances have been proposed 
for the disinfection of sewers, cesspools, and water-closets. 
The mercurial mineral salts are not applicable to sewers or 
drains, owing to the fact that they corrode the metallic pipes. 
Carbolic acid, crude, dissolved in water in the proportion of 
one to fifty, is a very efficient arrester of decomposition in 
drains and cesspools, and is in every way preferable. Calvert's 
powder, composed of about twenty-five parts of carbolic acid 
and seventy-five parts of alumina and silica, is applicable to 
the same conditions of use as quicklime. 

" The solid absorbent disinfectants, such as dry earth, char- 
coal, sulphate of iron, chloride of zinc, and chloride of lime, 
will be found to be efficient in drains and sinks under ordinary 
circumstances. It should be strictly enjoined, however, that 
under no circumstances are the dejecta of yellow fever, cholera, 
and typhoid fever patients to be emptied into sewers or privy- 
vaults until they have been thoroughly disinfected by the 
standard solution of mercuric chloride which has been recom- 
mended. Filth such as is found in closets, sinks, and privies, 
it should be remembered, is the chief source of nutrition for 
the different disease-germs, and therefore such places cannot be 
too clean nor avoided too widely. Let them be cleaned out 
often, after being disinfected ; and do not allow accumulations 
to take place under any circumstances, always remembering 



380 MOTHER AND CHILD. 

that bad odors are the best, if not a certain, indication that 
something is out of order and that there is danger ahead. 

" Sternberg advocates a dilute chloride-of-linie powder com- 
posed of one pound of chloride of lime and nine pounds of 
plaster of Paris. This is clean to handle, and can be sprinkled 
over everything fearlessly. 

" Perchloride of iron is useful for the disinfection of sewage, 
and when added to it throws down a precipitate of ferric oxide, 
which is due to its action upon the sulphide of ammonium 
nearly always present in sewage. It is conjectured that this 
reaction leads to the liberation of sulphur, which in turn acts 
as a disinfectant. 

" Permanganate of potassium prevents putrefaction in sew- 
age for a short time, and also acts as a deodorant ; but it is 
necessary to use it in large and expensive quantities to get 
these results, and hence it is not practical." 



CHAPTEE XL VI. 

ACUTE AND CHRONIC NASAL CATARRH. 

For the answers to the following questions, which are in- 
teresting to mothers in this connection, we are indebted to Dr. 
Alexander W. MacCoy, of Philadelphia. 

How to treat an ordinary cold in the head, with household reme- 
dies, for a child over six months of age. 

A cold in the head should never be neglected. At the be- 
ginning, an attack (ushered in by fits of sneezing and slight 
feverishness) can often be arrested before the watery flow be- 
gins by the prompt use of quinine suppositories, from one- 
half to two grains each, according to age, introduced into the 
bowel once or twice in the day; also small quantities of sweet 
spirits of nitre in iced water (or for older children in lemonade), 
taken freely. Sometimes large quantities of cold water taken 



ACUTE AND CHRONIC NASAL CATARRH. 381 

will act so promptly on kidneys and skin as to quickly relieve 
the nose. For some delicate children whiskey and water in 
proper doses may be used. Hot (mustard) foot-baths upon 
retiring is a time-honored and very efficacious treatment if the 
extremities are well protected during the night. If the nostrils 
show watery and mucous discharge, the nasal chambers should 
be looked after, and the stuffiness and stoppage to breathing 
through them must be combated by lubricating them within 
with bland oils dropped in or snuffed up or, better, used as a 
spray in an atomizer or vaporizer. Albolene and benzoin are two 
of the most agreeable and effective substances available; com- 
bined with a one-per-cent. to two-per-cent. solution of cocaine it 
is most efficient in relieving the nasal distress and stoppage, in 
the nostrils. Plain cosmoline and vaseline, warmed, and applied 
in and around the orifices of the nostrils, will greatly add to the 
comfort and repose of infants. Yery often infants suffer more 
from the accumulation and adherence of the secretion, which 
soon dries up and renders the small nasal orifices stiff, uncom- 
fortable, and occluded. The frequent application of a weak 
solution of baking soda (bicarbonate of soda) to the nostrils 
on a soft rag or absorbent cotton will easily remove this dried 
secretion, and if immediately followed by the free use of oil 
or cosmoline, will prevent this annoyance from recurring. 
Guarding the child from overheated rooms during the day, 
and especially at night, with the judicious use of quinine sup- 
positories and the application of some benzoin with camphor- 
ated oil in the nose, will generally relieve and cure an ordinary 
cold in the head in one or two days. 

1. At what age do children show symptoms of chronic post-nasal 
catarrh f What are its earliest symptoms f 

The time at which a discharge irom the head occurs, either 
from the nose or throat, may be coincident with the child's 
birth. An acute cold in the head often develops during the 
first week of life, and, followed by a succession of other at- 
tacks during the earlier months of infancy, may give rise to 
symptoms of chronic nasal catarrh as early, at least, as the 



382 MOTHER AND CHILD. 

first year. (Depending upon some hereditary taint, the symp- 
toms are familiarly known as " snuffles," and date from birth.) 
A post-nasal catarrh — a dropping of mucus or phlegm from the 
head into the throat — is only a symptom of a nasal catarrh ; 
without a nasal catarrh existing at the same time there can 
be no post-nasal discharge. It is probably true that, in young 
children, for a long time there is no actual inflammation behind 
the palate — post-nasal space — in discharges from the head 
into the throat, but the secretion comes from the back of the 
nose and slides down the palate into the throat ; the throat 
may look red, but this is caused solely by the mucus lying 
there or constantly passing over it. An acute cold in the head 
will give rise to a discharge into the throat, which in children 
will be much more noticeable in the recumbent position. This 
is also true in the chronic form. One of the earliest symptoms 
manifested in an infant or child suffering from nasal catarrh is 
a short, irritative cough, generally very persistent and occur- 
ring chiefly at night, disturbing the child's rest to a distressing 
degree. A cough arising from mucus flowing out of the back 
of the nose and down the throat, finally tickling the " speak- 
ing-box" (larynx), is not amenable to ordinary treatment by 
cough-syrups, etc., but requires the removal of the secretion 
from nose and throat. The cough comes on generally after 
the child has been asleep for some time and the recumbent 
position has started the secretion downward in the direction 
of gravity. During the day, the usual watery or mucous dis- 
charge from the nose is seen, and frequent attempts at swal- 
lowing may be noticed. It is quite unusual for parents or 
nurses to give much consideration to a cold in the head, and 
it is more rarely understood that this disturbing cough at night 
is dependent upon the state of the nasal passages. If a. cold in 
the head is overlooked or neglected, as is so often the case, the 
constant discharge of mucus into the space behind the palate 
and its continuous flow downward will, in time, produce an 
enlargement of a gland at the top of this space behind the 
palate, as well as cause a pharyngitis, which gives rise to a 



ACUTE AND CHRONIC NASAL CATARRH. 383 

serious condition and makes what is often called "a weak 
throat." And the trouble does not end here, but often causes 
change in the voice, rendering it husky and hoarse, and if left 
to itself, in many cases causes inflammation of the windpipe 
and also of the bronchial tubes ; and in very many subjects 
too often renders them weak-chested and liable to acquire 
some grave pulmonary disease. . In the space behind the palate, 
up in the roof, where this gland of which I have just spoken 
lies, an enlargement of the gland develops ; in some cases 
where this occurs the tissue hangs down over the nasal 
openings behind, and causes impeded breathing through the 
nose, producing mouth-breathing, and causing the voice to 
become flat and nasal in character. This nasal voice is also 
dependent upon obstruction in the nasal passages themselves, 
and gives the true explanation why we are said, as a nation, 
to " talk through our noses." 

2. Are there any precautions that can be taken to prevent it? 

The precautions necessaiy to be taken to prevent a chronic 
nasal catarrh are comprised under the hygiene of infants and 
children, and the adaptation of children, from birth, to their 
environments. It is a lamentable fact that infants and chil- 
dren suffer the greatest neglect of prop'er care of the nasal 
passages. From the first bath after birth onward, the 
mucous membrane of a child is put on the defensive. Too 
frequent bathing (daily) of infants and children, with much 
too warm water, in overheated rooms, followed by too little 
friction of the body, is a fruitful cause of " colds in the head." 
The important task of bathing is generally given over to the 
" child's nurse" after the first few months. This position is 
frequently filled by a young girl remarkable chiefly for her 
inexperience and stupidity. The little innocents are at the 
tender mercies of such persons, not only in the matter of 
bathing, but in that of dressing, undressing, proper regulation 
of amount of bedclothing, and ventilation of the bedchambers. 
If the natural guardians of children would give more atten- 
tion to the details of these daily matters of so great interest 



384 MOTHER AND CHILD. 

to the physical welfare of their offspring, the prevalent nasal 
catarrh would become much less frequently seen. Overheated 
bedrooms (furnace-heat night and day) and too many bed- 
clothes contribute greatly and promptly to an attack of cold 
in the head, or add to one already present. The child, after 
being asleep for one or two hours, is found bathed in sweat ; 
such discomfort renders it restless, and it naturally seeks 
relief, and is soon outside of the coverings. This condition of 
affairs, kept up night after night, soon renders the skin re- 
laxed, and greatly enhances the risk of taking cold from the 
rapid evaporation from the body. The selection of suitable 
bedclothing is an item of great importance to the child's 
welfare. Light, porous blankets are the only bed-coverings 
advised. Luxurious eider-down and wool comfortables, and 
all coverings of impervious character, are to be avoided. 
Eider-down is especially liable to be used, because of its light 
weight, when the atmospheric conditions do not warrant its 
use. It is only suitable for arctic climates and bedrooms 
without heat. A great amount of exercise in the open air 
(life in the country) is one of the best preventives of nasal 
catarrh. 

3. Should a child be taught to blow its nose f and should water 
be snuffed up by it to aid it, or its nose be washed out with a spray , 
daily f 

A child should be taught to blow its nose if done properly, 
but as the nose-blowing is generally done it is conducive of 
harm to the middle ear, and is thought by some to greatly 
increase the chances of earache and running ear. But if the 
handkerchief is simply placed under the nose and the dis- 
charge blown into it, there can only good results follow, viz. : 
emptying of the respiratory tract of the nose, and the pro- 
motion of free nasal respiration, — a very important function. 
Water should never be snuffed up the nose by children (or 
adults), except in case of nose-bleed, as it is apt to be painful 
and also bring about a feeling of fulness in the nose, and 
thereby increase the obstruction. Water well warmed, and 



ACUTE AND CHRONIC NASAL CATARRH. 385 

containing an alkali combined with carbolic acid, may be 
employed ; its value is greatly enhanced by the addition of 
glycerin. 1 Used in the form of a spray, it can be made quite 
efficient in dislodging the retained secretion, cleansing and 
purifying the passages. Unless the discharge is profuse and 
purulent, a spray of fluid cosmoline can be used to better 
advantage, often combined with some drug which has a heal- 
ing action. This simple remedy frequently suffices to effect a 
cure. 

4. If a child snores, can it be prevented ? Is it a sign of 
catarrh ? 

This question may be answered "yes" and "no." If a child 
snores, this may and often does arise from obstruction to nasal 
breathing produced by nasal occlusion in various parts of the 
canals. It also very frequently arises from enlargement of 
the tonsils, — probably the next most common condition causing 
mouth-breathing and rendering snoring possible. There are 
some cases of snoring in children that do not arise from any 
diseased condition of the mucous tract, but appear to come on 
during profound sleep, such as is often noticed in adults. 
Snoring in adults, in many cases, does not depend upon any 
obstruction in the nose or throat ; this I have often verified 
by careful inspection of subjects given to snoring. The pre- 
vention of snoring which is dependent upon disease will only 
be successful by removing the cause, — removal of all obstruc- 
tion and the cure of mouth-breathing. 

5. Should a child that hawks or snores use douche or spray ? 
If so, how often, and what should be used with it f 

Very young children never hawk ; the act of swallowing 
repeatedly or coughing takes the place of hawking, and the 
secretion in the fauces and post-nasal space is generally swal- 
lowed, as in infants. A nasal douche should never be used for 
a child except in cases of dry or fetid catarrh, when it is of 
great use in expelling the retained secretion. A douche used 

1 Dobell's solution, with a Davidson atomizer, !No. 63. 
B. z 33 



386 MOTHER AND CHILD. 

under any other circumstances as a treatment for children is 
liable to do much harm to the middle ear and increase the 
cold in the head. As said before, a spray can be used with 
advantage, but only as often as is compulsory, say once or 
twice a day, and even then the mildest solution should be 
used, — one or two grains to the ounce of boracic acid, chlorate 
of potassium, in glycerin and water, or, better, benzoin or 
albolene combined with tar-camphor or menthol. Medication 
of the nasal chambers can be very efficiently instituted by 
the use of the " Oliver vaporizer," using fluid cosmoline or 
glycerin, to which may be added such drugs as are suited to 
the condition. 

6. Please give all the best methods for stopping nose-bleed. 

Nose-bleeding occurs in the vast majority of cases in chil- 
dren from a superficial ulceration on some portion of the 
middle line of the nose, just within the opening of the nostril. 
This abrasion is caused from picking the nose, the finger-nail 
or handkerchief scraj)ing off the outer layer of the mucous 
membrane. This superficial ulcer on the middle line remains 
unhealed for a long time, by reason of the free motion in the 
parts in blowing the nose, together with the low vitality of 
this thin mucous membrane covering the cartilage. Aside 
From injuries (falls, blows, and sharp substances thrust up the 
nostrils), the ulcer is the source of most of the nose-bleeds. 
Blowing the nose and wiping it with too much vigor, attacks 
of sneezing, cough, etc., also bring about the flow. Remem- 
bering that the seat of the bleeding is very low down in 
the nostril, and not high up, as is generally supposed, the ease 
with whicli the hemorrhage can be arrested by a little pressure 
will add greatly to the prompt and successful treatment of 
these attacks. The finger (if the child's nostril is sufficiently 
large) can be introduced and pressed up against the middle 
line of the nose for a sufficient length of time to stop the 
bleeding. Then, carefully withdrawing the finger and pro- 
hibiting blowing of the nose will often be sufficient. If the 
opening of the nostril is too small to allow the finger to be 



ACUTE AND CHRONIC NASAL CATARRH. 387 

introduced, enough cotton, wool, or soft sponge, can be pushed 
into the orifice to slightly distend the nostril, and pressure 
made against the outside of the nostril with the finger. If 
kept up long enough this will often succeed. If the bleeding 
has been great, or long continued, saturating the cotton with 
some astringent, such as a weak solution of alum, tannin, or 
tincture of iron, will cause arrest of the bleeding much more 
promptly. Probably the most satisfactory astringent to use 
on cotton is the watery extract of witch-hazel, familiarly known 
as " Pond's extract." Saturating the piece of absorbent cotton 
or sponge and squeezing out about one-half, then introducing 
into the nostril, will be immediately successful. If there 
should be too much nervousness to try the introduction of 
any of these substances, a simpler plan is to apply ice or iced 
water to the nose, forehead, or back of neck at short intervals. 
Cold water snuffed up gently will often arrest the hemorrhage, 
or, if the child is too young to snuff up fluid, it can be squirted 
up the nostril with a small syringe. If urgent, extract of 
witch-hazel had better be used, and it will be with the hap- 
piest effect. It can be used full strength, but is painful, and 
had better be diluted with water, one-half or two-thirds in 
very young children, and in proportion in older ones. The 
witch-hazel is in most cases entirely satisfactory, but if, after 
all these methods have been tried, the bleeding continues, a 
surgeon must be called and the nostrils plugged more perfectly. 
The position generally assumed in nose bleed — that of holding 
the head downward over some vessel — is a very bad one and 
should be avoided. The head should be held more erect, and 
the blood allowed to flow into a towel, handkerchief, sponge, 
or absorbent cotton. To make a permanent cure, the ulcer — 
the cause of the bleeding — must be removed. This will have 
to be done by one sufficiently skilled to examine the nose care- 
fully and treat the parts intelligently. The ulcer is often slow 
in getting well unless carefully managed. If the nose-bleeding 
arises from some other cause, or during an aitack of acute 
illness, the nose should be promptly examined with a good 



388 MOTHER AND CHILD. 

light and the cause discovered and removed by the surgeon. 
At times, in children of plethoric habit, a small bleeding at 
the nose need not make the parent feel at all anxious, but it 
may be looked upon as simply an attempt of nature to get 
rid of too much pressure in the blood-vessels. 



CHAPTEE XLVIL 

DISEASES OF THE EYE. 1 

To the laity, almost all inflammations of the eyes of new. 
born babes are known as " ophthalmia ;" but we want to specify 
and say that physicians, in a general way, recognize two forms. 
One caused by cold — the harmless variety — can be easily cured 
by careful cleansing and the use of astringent washes, such as 
rose-water or alum or borax (one grain to one ounce of water). 
The other, a most dangerous and easily-contracted disease, 
threatens blindness. This latter form is not apt to spread 
among careful people, at their homes, but at public institu- 
tions, unless isolated at once, will be sure to sweep through 
and attack every child. 

Just here we want to call the attention of those interested 
in " Day Nurseries" where frequently enough care is not ex- 
ercised. No child with a suspicion of "sore eyes 1 ' should be 
admitted, whatever be the excuse, for physician and manage- 
ment alike are morally and legally responsible for eyes lost, 
even though their work be purely one of charity. 

If asked how a baby's eyes should be treated immediately 
after birth, we would say, certainly not to a dose of soapsuds 
in the — to be condemned — popular primary scrubbing with 
which many a poor babe is tortured. The bad colds (snuffles) 

1 For this chapter we are indebted to Dr. Charles S. Turnbull, of Phila- 
delphia. 



DISEASES OF THE EVE. 389 

which attack such over-scrubbed babies affect the eyes, as well 
as the nose and throat, and often alarm the medical attendant 
and worry the mother and nurse. 

If, as in such cases, the eye looks red and the secretion be 
gummy and sticky, like the white of an egg, or if a yellowish- 
white discharge be present, gathering in the corner of the eye, 
or perhaps gumming the lids together, we have a simple (benign) 
case of inflammation (conjunctivitis), and a soothing eye-wash, 
composed of 

Borax, five grains ; 

Paregoric, one teaspoonful ; 

Infusion of sassafras pith, eight tablespoonfuls, 

should be frequently applied with a pledget of absorbent cot- 
ton, and about twice, early in the day, a few drops maybe 
allowed to run between the open lids. 

Should, however, the eyelids, within the first twenty-four hours, 
puff up and swell, so that the eye cannot be opened, and particu- 
larly should the secretion oozing from between the lids be creamy 
and of a yellowish, pinkish, or greenish color, then look out; the 
dread ophthalmia has started} 

Ophthalmia of the new-born is the disease which contributes 
so largely to the causes of blindness in our asylums, and calls 
for the most heroic treatment on the part of the medical at- 
tendant, and eternal vigilance on the part of the nurse. At 
this juncture both physician and nurse must incessantly and 

1 Our first anxiety must be for the full dilatation of the pupils, and to this 
end the doctor will use one drop of the " atropine solution," put into the 
eye (at its outer angle) twice each day. 

Atropine, one grain ; 

Water (boiled), two teaspoonfuls. 

The bottle containing these drops should be marked " Poison," and must 
be kept under lock and key. If after the instillation of one drop of the 
atropine solution the baby's skin should become red, and look as if it had 
scarlet fever, it has been poisoned (harmlessly) ; but do not put another 
drop into the eyes until you have talked with your doctor. 



390 MOTHER AND CHILD. 

conservatively, yet resolutely, attack the disease, and unceas- 
ingly fight night and day. 

The swelling and inflammation must be combated by cold 
.applications, day and night, made by means of small pledgets 
of linen, which are lifted cold and wet from a block of ice and 
laid upon the eye ; but be careful that they cover no more than 
the burning eyelids. These pledgets will be required to be re- 
newed frequently, at intervals of from fifteen to twenty 
minutes. The lids, at the same time, must be gently sepa- 
rated, and the discharge allowed to escape, or be carefully 
wiped away with pieces of absorbent cotton, dipped in fresh 
water or salt, borax, or corrosive sublimate (one to ten thou- 
sand), to make a weak solution. 1 

Use vaseline to anoint the eyelids, cheeks, and to grease the 
eyelashes (cilia), to prevent their sticking together from se- 
cretion, which must always be encouraged to escape. 

Sponges are dangerous. Never use them. Use absorbent 
cotton or " lintine," as it is clean and can easily be disposed of. 
Burn it. 

Great care must be exercised that the cold applications be 
not kept up too long at one time, — i.e., without intervals of a 
few minutes' rest, say fifteen minutes every two hours. They 
have only to be continued until the swelling of the lids and the 

1 The doctor should, in the absence of the apothecary, be willing to per- 
sonally supervise the daily preparation of a peculiar sort of " antiseptic 
wash," to which we wish to call particular attention, which we have been 
using for some years with unusual success in the treatment of purulent 
ophthalmia of the new-born. We find this wash invaluable in every case 
of specific ophthalmia. It is in reality a " mercurial wash" equal to about 
one to four thousand ; nevertheless, we invariably insist upon the solution 
being made up according to the following formula : 

Red oxide of mercury (hydrarg. biniodi. rub.), one grain : 
Iodide of potassium, two grains ; 
Water (boiled), eight ounces. 

To be used with a pledget of absorbent cotton or in irrigating the eye 
with a pipette. 



DISEASES OF THE EYE. 391 

profuse creamy discharge have disappeared. Be careful also 
about the ears, and see that no water trickles into them ; also 
see that the hair be kept dry, and the pillow as well; and be 
most particular that the patient's and attendant's hands are 
kept clean and neve_r put near the face, for fear of inoculation, 
always regarding the discharge and every sort of eye-wash 
used as rank poison. 

So long as the discharge be creamy, it must b.e considered as 
corrosive in its effects upon the eyes (like acid or vitriol), and 
it is during the first stage, when the swelling is so great that 
the lids cannot be opened, that the following " anodyne wash," 
to be repeated (instead of the mercurial wash) every three 
hours, must be gently squirted (with a round-end medicine- 
dropper) from the inner (nasal) angle of the fissure between 
the eyelids, — 

Sulphate of morphine, two grains ; 
Chloride of zinc, two grains ; 
Rose-water, ten drops ; 
Distilled water, five tablespoonfuls. 

Now recollect, such eyes cannot be watched and cleansed 
and treated up to bedtime and then neglected because the 
baby or its attendants sleep. Oh no ! Lest the little one's 
eyes melt away during the night. Long naps are not desir- 
able neither for the children nor the nurse, as " a good night's 
rest" has cost many an eye. We repeat, the treatment must be 
kept up night and day. We have said the secretion is corrosive 
in its action upon the structures of the child's eyes, and as 
the eyeball, from pressure of swelling, is damaged, the dis- 
charge is doubly dangerous. Then, too, the child might turn 
on one side in its bed, and the discharge, by gravity, would 
run into and inoculate the fellow-eye. This is not all; it 
is deadly poison when transplanted to any other person's eye, 
and nurses, mothers, and medical attendants cannot be too 
careful. Even the poor laundress often becomes a victim, and 
this poison has too often been the cause of the loss of valuable 



392 MOTHER AND CHILD 

eyes, to which, through ignorance or carelessness, it has, by 
touch only, been conveyed. Keep the poor little one's excori- 
ated cheeks and skin, rubbed raw by washing, we repeat, well 
anointed with vaseline ; so also the edges of the eyelids, nose, 
and nostrils. Keep pledgets of cotton (not absorbent cotton) 
in the ears. Keep the patient's strength up by extra and 
tempting diet, and give the usual fever mixtures, — "sweet 
spirits of nitre," quinine, and, perhaps, anodynes. 

The baby's sleep will be greatly disturbed, its nervous 
system racked ; it may take cold, it may become sick, it may 
die from irritation and exposure. Take the risk, and if you 
filter in accepting the odds, think of the heart-rending appeal 
of a pair of sightless orbs. Think that the flaxen-haired girl 
might be a u blind Nydia," or tbe boy a dependent, helpless 
man. We are emphatic, because we have seen the deplorable 
ravages of the disease we have but partially described: so we 
urgently warn you to immediately care for it, and promptly 
seek counsel and experience to fight this dreadful disease. It 
blinds other individuals in families; it blinds children in our 
asylums, and two or three at a time ; it blinds grand nurses, 
loving, faithful Sisters of Charity, and even prominent and 
skilful physicians. 

Unless a physician be at hand to apply local caustic reme- 
dies himself, we consider it criminal to recommend such, or, even 
worse, to order caustic solutions to be dropped into the eyes. The 
physician only must turn the lids, brush over any caustic 
solution necessary, and immediately (for fear of over-effect or 
damage to cornea) wash it off again ; but stronger applications 
than those we have named must not be permitted for home 
use. 

We have only referred to the treatment of individual cases 
at home. In asylums, where infants are brought in daily, we 
insist upon immediate isolation of the child as well as its 
attendants and their wash. 

If this disease in any case be progressing to a favorable ter- 
mination, the discharge will become less, the swelling of the 



DISEASES OF THE EYE. 393 

eyelids will diminish, and the child will be able to open its 
eyes. At this stage we commence the use of a slightly-stimu- 
lating salve, — 

Yellow oxide of mercury, one grain ; 
Vaseline, three drachms, — 

to be rubbed on the edges of the eyelids about three or four 
times a day, or just before the babe goes to sleep. Beyond 
this we cannot advise any other treatment save that which 
your medical attendant may order. 

We would with this disorder make an exception, and say 
that without medical advice and guidance " ophthalmia in the 
new-born" must, as a rule, mean blindness, whether of one or 
both eyes. In the contagious ophthalmia of asylums, where 
one sore-eyed baby poisons the rest, and where simple yet 
decided local treatment is required, we particularly commend 
a peculiar compound called fifty-per-cent. " boro glyceride." 
This is made by boiling together boric acid and glycerin — 
sixty-two parts of the former to ninety parts of the latter — 
until the product loses weight and weighs but one hundred 
parts. This, on cooling, resembles in consistency and appear- 
ance ice or " glacial phosphoric acid," and is found to be very 
hygroscopic. To dilute it, glycerin must be employed ; and 
the best method for its preparation is, when freshly made, to 
add to it glycerin in such proportion as to make a fifty-per- 
cent, solution. This makes a preparation of the consistency 
of honey, to which can be added iodine, tannin, resorcin, car- 
bolic acid, iodoform, morphine, atropine, eserine, etc., as may be 
desired. 

Ointment of boro-glyceride is made after the following for- 
mula : 

Solution of boro-glyceride, fifty per cent., two drachms ; 

Vaseline, six drachms ; 

Oil of rose, a drop or two. Make an ointment. 

This makes a thoroughly stable ointment, which neither 
becomes granular nor precipitates the boric acid. We feel 



394 MOTHER AND CHILD. 

confident that in this compound we have a most valuable 
remedy, and when called upon to combat the appalling epi- 
demic, such as so often occurs in our asylums, we feel much 
more secure — especially in the case of young children — when 
using this excellent remedy. The fifty- per cent, solution of 
boro glyceride, on account of its great affinity for water, and 
the rapidity with which it absorbs it and liberates the finely- 
divided particles of boric acid, not only acts as an astringent 
but also as an antiseptic. We believe that it is just the sub- 
stance that we are in need of for the treatment of all forms 
of chronic inflammation of the eyelids, especially " contagious 
or asylum ophthalmia." 

The use of the ointment mentioned we consider an essential 
part of the " boro-glyceride treatment," and it must be con- 
tinued for at least two months after all discharge has ceased. 

This disease, like every form of ophthalmia, is only trans- 
mitted by inoculation, and under proper care need not be 
transmitted even to the fellow-eye. 

What is proper care ? Proper care is such as can only be 
secured by two skilled and trusty nurses, — the one for the day, 
the other for the night, — who are never to leave the patient 
alone ; or, as an extra precaution, better say four attendants, 
so that one of the two on duty will be sure to keep awake. 

As soon as the little sufferer shows the least tendency to open 
its eyes, it should be encouraged in its endeavors. Darken the 
room moderately, so that the influence of the bright light does 
not 'cause spasmodic closure of the eyelids. The opening of 
the eye is beneficial in two ways, — the movements of the lids 
work the corrosive secretion out from between the eyelids and 
stimulate the circulation in the affected parts. 

When a child opens its eyes the danger is generally over, 
only we must not relax our vigilance, for a relapse must not be 
allowed to occur. The ice applications, we repeat for em- 
phasis, have only to be continued until the swelling of the 
lids and the profuse creamy character of the discharge have 
disappeared. ]STo child need lose its eyes from purulent oph- 



DISEASES OF THE EYE. 395 

thalmia, and no child does, if faithfully treated in the way just 
described." 

Dr. H. Knapp says be is convinced that nothing is so power- 
ful in diminishing the violence of tbis dreadful inflammation 
as cold, and be is afraid that warmth may temporarily increase 
it, and favor destruction of the eye ; and says, furthermore, 
" among all questions in ophthalmology, — that of cataract, per- 
haps, excepted, — there is none so important as the treatment 
of contagious ophthalmia." 

Spots like pimples (called pustules) are often seen on the eyes 
of children during warm weather, especially troubling those 
suffering from disordered digestion. These pustules may come 
on the clear part of the eye (cornea), or upon the white or pink 
part of the ball of the eye (conjunctiva). They are painful, 
and cause profuse watering of the eye (lachrymation) and 
dread of the light (photophobia). The child usually burrows 
its head into the nurse's shoulder, its pillow, or a chair or sofa 
cushion, and being fretful and wofully unhappy and uncom- 
fortable, becomes a frightful (no other word expresses it) care 
to both nurse and mother. With its head burrowed into a pil- 
low, especially a feather one, it is in the condition of a child 
with a poultice to both eyes. The tears wet the pillow, the 
face keeps it warm, and hourly the eyes grow worse. Such 
cases must be cared for at once, as the affection lasts from 
weeks to months, and even years, wrecking the health of both 
the child and its attendant. By force or persuasion the little 
one must be kept on its back when in bed in a darkened room. Use 
a hair pillow. 

The successful treatment of such cases depends upon our 
ability to be particularly attentive to hygiene and diet. 'Regu- 
larity of feeding (meals), the omission of all forms of starchy and 
sweet foods, selecting milk, soft-boiled eggs, rare meat, broth, 
and if it must be, stale (baker's) bread. A sponge-bath each 
morning we urge as an essential in the treatment of " phlyc- 
tenular ophthalmia" (keratitis or conjunctivitis), as the doctors 
call it. This sponge-bath we order for children over two years 



396 MOTHER AND CHILD. 

of age, to be given each morning. Sponge quickly with warm 
or even hot water, and immediately follow with cold water ; 
such cold water as would be about the temperature of ordinary 
apartments,— -z'.e., 65° to 70° F. 

Indiscretion in diet is apt to cause a recurrence of the trouble, 
which as a relapse will always be more severe than the primary 
attack. We formerly used atropine (belladonna) to dilate the 
pupils in such cases, but now we use eserine (Calabar bean) to 
contract the pupils. By this means we secure a beneficial effect 
locally, by making the pupil smaller, and mechanically keep 
out the light, which is painfully irritating and annoying. The 
solution we recommend is, — 

Salicylate of eserine, one-half grain ; 
"Water (boiled), two drachms. 

Mark " Poison." Pat one drop into the eyes two or three 
times a day. (Druggists must dispense this solution in dark 
glass or paper-covered bottles.) 

Keep the apartments well ventilated but darkened, hence cooler, 
and take the child out at night, say between sunset and bed- 
time (10 p.m.). Do not be anxious for fear it may " take cold." 
Air from fresh water, such as we secure on lake or river (ferry- 
boat), is especially good. A sun-bonnet is the proper " head- 
gear" for children with irritable eyes, be they caused by this or 
any other inflammatory trouble. Make the sun-bonnet out of 
" wash goods," with casings into which to slip, in and out, strips 
of card or pasteboard, which will give the bonnet stiffness. 
These strips of pasteboard can be removed when the bonnet is 
washed, and easily replaced. Starched bonnets will not answer 
for children who use them as eye-shades, as the stiffness will 
not last any time. 

Permit us in this connection to recommend woven-wire or hair 
pillows, or, still better, a combination of both, which can be 
had in this city ; and for baby beds and pillows we cordially 
endorse this innovation. ]STote how infants and children per- 
spire when sleeping, and how hot they seem about their heads, 



DISEASES OF THE EYE. 397 

and try hair or wire mattress and pillows, and you will have 
the o^reat satisfaction of making the little ones both comfort- 
able and more healthy. 

For burns of the eye, drop into the eye clean sweet castor oil, — if 
by mistake anything has been dropped into the eye, like am- 
monia or other caustic, or it may be, spilled hot water or tea, 
or even whitewash, etc., after cleansing as thoroughly as pos- 
sible. 

Stoppage of the tear-duct (occlusion) accompanying nasal 
trouble may be temporary, and soon disappear after the use 
of a wash of powdered borax and water (a pinch to a wine- 
glass of water), always remembering to anoint the inside of 
the nostrils with cosmoline or other grease. Continued occlu- 
sion may cause abscess of the tear-sac at the inner corner of the 
eye, alongside of the nose. This must have the surgeon's 
immediate attention. 

Wounds of the eye, either incised and from pieces of flying 
glass, scissor-points, or fork-tines; cuts or tears from flying 
fragments of stone or metal, or impinged pieces of stick or wire, 
must not be meddled with. Better not bandage, but devote every 
effort to keep the child's hand away from its eye. If the 
doctor cannot be seen within a few hours, ask your druggist 
for the proper solution of atropine (belladonna), and put one 
or two drops between the lids. 

In every case, better omit any interference with an injured eye 
than fight your little patient. 

The rule to-day is not to confine, by tying up or bandaging, 
all operated eyes ; hence the advisability of following the above 
rule. 

Bleeding (hemorrhage) from the eye usually means a damaged 
eyelid ; seldom is it that the eye bleeds. Injuries involving the 
edges of the eyelid call for careful adaptation of the parts, and, 
if at all possible, the parts must be carefully stitched. If such 
damaged lids are left to heal, Nature, strange to say, seems to 
forget herself, and the scar produces a marked deformity, and 
when the lashes are, by malposition, turned in upon the eye, 

84 



398 MOTHER AND CHILD. 

great damage to the member usually results, to say nothing of 
the discomfort from the scratching of the misplaced eyelashes. 
Where the cut has at the same time so damaged an eye as to 
cause its contents to " run out," great pain, usually absent in 
other grave injuries, will call for absolute rest and, a soft cotton 
pledget to close the lids of both eyes ; this pledget to be held 
in place by a light cheese-cloth bandage until you can hunt 
up your doctor. 

Close both eyes if you would keep one eye at rest. 

Squint, or cross-eye, makes its appearance at any time after 
the fourth or sixth month. Just as soon as the baby uses one 
or both eyes the defect should be looked after, because if taken 
in time but few cases ever come to operation, and in some 
instances not even glasses will be required. We venture in a 
general way to promise parents who heed this warning immu- 
nity from the annoyance of squinting children. 

Paralysis of the upper eyelid, usually congenital, involving one, 
seldom both lids, must not be allowed to remain uninterfered 
with, because by covering the eye, squinting and loss of vision 
are induced (cross eye), and the child's head is given a most 
unnatural position. The head is constantly tilted backward. 
Such cases require the surgeon's attention after massage has 
been given a thorough trial. 

Instinct teaches a child to rub its eyes with its fist. Would that 
adults would take heed and do the same, and so save themselves 
from infection from " dirty fingers." 

Provide your children with broad-brimmed hats or sun-bonnets 
for protection against the strong sunlight of summer-time, and 
shade the eyes of the babies, as they, lie upon their backs in 
their baby-coaches. 

Forget about the " alum-curd" and piece of raw beef as an eye- 
poultice. Milk of any sort must not be used as an application 
for the eyes. All these substances are poisonously dangerous. 

Always put your baby to sleep in the dark, and when it awakens 
admit the light gradually. Do not forget and rush with it 
into a brilliantly-lighted apartment. 



DISEASES OF THE EAR. 399 

No child should go to school before the seventh year. 
Modern "kindergarten" systems, as a rnle, develop eye- 
defects, and, in our opinion, damage children's eyesight. 



CHAPTEE XLVIII. 

DISEASES OF THE EAR. 1 

The symptoms of earache in a babe are so vague as at first 
not to be distinguishable from other forms of irritation. Ex- 
cept slight fever, more or less restlessness, rolling of the head 
from side to side, perhaps backward burrowing into the pillow, 
nothing is noticed until the attendant reports a " running ear." 
The drum or middle ear fills with a watery-like fluid (the 
watery part of the blood, serum), or it may look like pure 
blood, which fluid, by pressure, causes more or less severe 
pain, and subsequently breaks through the drum-membrane 
and escapes from the ear. Often the perforation closes over 
night, and apart from the coating of the auditory canal with 
a whitish residue from the serum, or staining of the external 
ear from blood, nothing is noticed. The perforation, however, 
does not always heal. It may remain open for some time, — 
this being apt to occur in weak or strumous children. In 
some cases it never closes nor does it materially interfere with 
hearing-power. 

Discharges frow, the ear — caused by " taking cold" — behave 
like, and may be compared to, the discharge from the nostrils 
under similar circumstances. The secretion is first watery, 
then thin mucus, followed by thicker stringy or tough mucus, 
then by '• matter" (pus), and last of all badly-smelling matter 
(fetid discharge). Discharges from the ear should only be 

1 For this chapter we are indebted to Dr. Charles S. Turnbull, of Phila- 
delphia. 



400 MOTHER AND CHILD. 

carefully wiped out with plain absorbent or, better, sublimated 
or borated (the so-called " medicated") cotton. Do not on any 
account allow rags or a pocket-handkerchief to be used for 
cleansing purposes, nor use cotton to plug tbe ear. When the 
discharge is offensive there is danger ahead, and if the doctor 
has not been called, now is the time. 

If a babe seem to have earache, until competent advice is at 
hand, have resort to the hot foot-bath, and use dry heat to the 
ear, — the "hot-water bag" or hot salt in a flannel bag; never 
forgetting, when the pain is not relieved, paregoric, which drug, 
properly labelled and directions carefully read, will stand you 
in good stead. Further than this, your doctor must prescribe 
all necessary medicines. 

We strenuously object to the use of drops of any kind. 
Water or other fluids must not be dropped or syringed into 
the ear. Fluid so used makes a subsequent ocular examina- 
tion of the ear quite impossible on the part of the doctor, and 
syringing with water macerates the parts and retards the subse- 
quent healing process. Healthy babes' " running" ears always 
get well if they are kept clean, as directed, and not meddled 
with : so recollect that sins against the ears of children are more 
usually those of commission tban of omission. 

Soap and water we consider poisonous to the ear, and the 
picture, familiar to almost every one, usually accompanying 
advertisements of soap, shows the grandmother washing her 
boy's ears with soap. It may have been the way " in the 
olden time," but the expression of the boy's face goes to show 
that nature would teach him to protest, if he dared ; now we 
are pleading his cause and begging mothers not to allow soap 
and water to be used. Children naturally rebel, and interfer- 
ence with their ears is generally a cause of war in the nursery ; 
and it is just here we wish to put in a plea for the juveniles, 
and condemn the usual practices of the best-intentioned 
mothers and nurses. 

In cleansing discharging ears, or attempting to thoroughly 
free the auditory canal, never swab it out, but use fluffy 



DISEASES OF THE EAR. 401 

pledgets of absorbent cotton gently pushed into the meatus, 
carefully agitate with the little finger, and so long as the dis- 
charge can be wiped out continue to use pledget after pledget. 
Never use anything smaller than the little finger, to force cotton, 
in wiping the auditory canal. Deeper wiping is forbidden in 
the case of children : the innermost parts will not suffer. In 
adults, where the secretion mechanically interferes with hear- 
ing, other methods may be employed. In larger children or 
adults Valsalva's experiment may be employed. This proced- 
ure, which the aurists term "auto-inflation" is accomplished 
by shutting the mouth firmly, holding the nose tightly, and 
blowing with one's " might and main," so that the air, not 
being able to escape through the mouth and nose, must be 
forced up through the Eustachian tube, out of the middle ear 
through the perforation and into the auditory canal, taking 
with it all the secretion which may block the way. 

In syringing ears, except for collections of wax or of foreign 
bodies, there is danger, especially in children, from impure 
water and varying temperature. The auditory canal, in chil- 
dren, is particularly short, and another source of danger is the 
susceptibility of the parts, from anatomical relations ; particu- 
larly, contiguity of the brain. 

Most discharges from the ear, in our opinion, unless they be 
sour or fetid, strange as it may seem, must be regarded as 
harmless in so far as hearing is concerned, provided there has 
been no meddling, no water used, and the general directions 
just given have been carefully followed. 

Now, how can this all-important process be accomplished in 
the case of children ? In only one way, — by forcible inflation, 
or by having them blow their noses. Every child should be 
taught to blow its nose. If it has not been taught to free the 
nostrils of mucus, its chances of retaining hearing-power in 
cases of disease of the ear are much poorer than in the case 
of one who has learned to blow its nose. In using the word 
child in this connection, we refer to those between four and 
twelve years of age. Younger than four need no such meddle- 
aa 34* 



402 MOTHER AND CHILD. 

some interference ; older than twelve are more amenable to 
treatment, as a rule, than adults. 

Our method of inflating the middle ear for children of tender 
years carries with it no alarm, and it is rather the rule than 
the exception for us "to have a good time of it" together. 
First, induce the little one to blow, as if blowing out a light 
(and if necessary strike a match and show it how to blow 
it out). Having won the child's confidence, place one end of 
an ordinary otoscope (substantial piece of black rubber, one- 
sixteenth-inch hosing, about two feet long) in the nostril of the 
side to be treated and with the other end in your mouth, having 
taken the precaution to close the child's other nostril, give a 
gentle blow or puff to show the child what you propose doing. 
As the child blows we puff a little harder, and as we grow en- 
thusiastic over the sport our little one blows vigorously, and 
we give a forcible simultaneous blow which forces the air up 
the Eustachian tube into the middle ear. In nine cases out 
of ten children clap their hands to the ears and say they 
have heard the air enter. 

Win the confidence of the little ones by patience, gentle- 
ness, and tact, and their treatment will be an oasis in the day's 
practice among adults. 

Because we advocate the educating of all children in the 
art of blowing their noses, we wish it to be distinctly under- 
stood that, as a habit, we would condemn it. Children left to 
themselves, except for the habit of mimicry, would never 
think of blowing their noses. Our practice, be it in the pri- 
vate office, hospital, or dispensary, is, as a rule, confined to 
those children carrying handkerchiefs, which from time to 
time are more or less vigorously used. Such blowers, as a 
rule, are our patients for running ears. Those who sniffle all 
day long, unpleasant as it may sound, or wipe their noses — 
dreadful as it may seem — on their dress-sleeves, seldom, if ever, 
are annoyed with running ears. 

Allow us to score a point in this connection. When a child 
suffers with ordinary influenza, "a cold in the head," allow it 



DISEASES OF THE EAR. 403 

to sniffle, nay, urge it to do so (and the same is the case in 
adults), and take our word for it, the duration of the attack — 
although made, if possible, more annoying — will be greatly 
shortened ; the watery secretions will give way to a thick 
jelly-like collection which will soon change to the natural 
mucus of the parts, and all of a sudden the " cold" will disap- 
pear, leaving no unpleasant symptoms such as usually follow 
in the cases of those who have not moral courage enough to 
refrain from blowing their noses. 

The great secret in the successful treatment of all discharges 
from the ears is the recognition of the fact that, so long as the dis- 
charge is not allowed to ferment, it will not become fetid, seldom 
ever purulent. 

As soon as the discharge from the ear makes its appearance, 
something is invariably dropped into it, or, in conformity with 
custom, it must be " syringed out." Kothing is more damaging 
to the successful termination of such cases. We would not 
complain if pure warm water were used to syringe the ear, or, 
still better, if a salty or alkaline solution were used, but the 
" Castile soap" is invariably added. Perhaps warm milk may 
be used. The soapsuds make an irritating solution, the milk 
one> that rapidly ferments and becomes acid, so that the audi- 
tory canal — it may be a warm cavity filled with simple mucus 
or perhaps serum — is converted into one that is inflamed and 
filled with a fermenting fluid. What next is done ? A fluffy 
piece of cotton is rolled into a dense mass and stuffed into the 
ear. The sour, fermenting, perhaps fetid mass, now corked 
up, fairly boils, and, where a harmless inflammation was in ex- 
istence, an active and dangerous one has certainly been started. 

To remedy affections of the ear general surgery has done 
but little; in most instances medical men are glad to get rid of 
" patients with running ears ;" and this, added to the prejudices 
in the minds of the community at large, and in some of the 
profession, too, after the injurious effect of healing or " drying 
up," as it is termed, discharges from the ear, has caused this 
affection, through ignorance or apathy, to be much neglected. 



404 MOTHER AND CHILD. 

We cannot, in this connection, omit a quotation from Saunders 1 
(a.d. 1806 /). He tersely ventures a question or two concerning 
those prejudices which even to-day, alas ! are urged against 
the cure of running ears. 

" What argument can be assigned against the cure of this 
disease that is not equally conclusive against all others? Is 
any one an abetter of the obsolete humoral pathology? He 
will contend that the stoppage of a drain which nature has 
established is pernicious, and the morbid matter will be deter- 
mined on the internal part ; but how can such person venture 
on the treatment of any disease, even the healing of a common 
ulcer? Some years ago I thought this absurd doctrine had 
been totally exploded, and yet I constantly hear it adduced to 
deter parties from interfering with this disease. Is a child 
subject to it, some other subterfuge, equally futile, is employed. 
The truth is, the disease is always tedious and difficult, and 
not always curable, and many are disinclined to embarrass 
themselves with the case who have not the candor to make 
the true statement." 

We have often been met with the objection, — and we must 
confess it is generally well put, — " Why dry up the discharge 
from the ear, since, when suppuration is actually taking place, 
patients, as a rule, hear better?" True enough, as the dis- 
charge ceases in the case of a running ear, hearing-power is 
usually materially diminished ; but we always make the reply 
by asking the question, " Which is better, half a loaf or no 
loaf?" That is, had we not better stop the discharge and 
save some hearing which will be permanent , or allow the dis- 
charge to continue and destroy the parts, and in greater or 
less time lose all hearing? Then, too, if only for the abolition 
of the disgusting fetor which accompanies such cases, if for 
nothing else, it is well worth while risking any fancied exten- 
sion of the inflammatory process. Children with "running 
ears" are tabooed by their school- and play-mates. So, like adults, 

1 John C. Saunders, M.D.. The Anatomy of the Human Ear, etc. 



DISEASES OF THE EAR. 405 

they are tolerated, while, self-conscious of the sickening odor 
from their ears, they shun society and companions, and imagine, 
not without good cause, that every one is aware of their in- 
firmity. The majority of such patients are generally willing 
to forego the greater or less amount of loss of hearing-power, — 
usually temporary, — if the offensive discharge can be prevented. 

Beyond a doubt a discharging ear is "a thorn in the flesh." It 
must be removed in the shortest possible time. Apart from the 
risk of damage likely to occur from a chronic discharge from 
the ear, the hearing and subsequent happiness of the individual 
is undoubtedly compromised, to say nothing of the unfortunate's 
health. Fetid ear-discharges run down into the throat and 
poison the system. This is no fancied deduction, but a fact. 
By simple cleansing of the ears and teaching our patients 
how, by Valsalva's method, to blow the air and with it the 
discharge outward from the middle ear into the auditory canal, 
which we must keep thoroughly cleansed, we have met with 
most pleasing results in these same children, who, from pale 
and emaciated subjects, have grown to be fat and ruddy speci- 
mens of humanity. 

Again, we are often confronted with the objection that "If 
the discharges from the ear should be stopped the disease will 
go to the brain." How did this idea originate? Because 
heretofore such heroic measures were used to check the dis- 
charge, because into the ears such caustic solutions were poured, 
and powders were insufflated ; furthermore, because no intelli- 
gent treatment was employed. In the majority of cases no 
regular ocular inspection of the parts was ever made, and ex- 
tension of inflammation and disease to the inner ear, or even 
brain, resulted. 

The majority of cases of running ears in children under two 
years of age would recover, and the hearing would not be damaged, 
if they were simply let alone. 

]S~ow this statement may seem startling, but it is neverthe- 
less true. Ordinary cleanliness is all that is necessary for the 
proper management of such eases. In the use of medicated 



v 406 MOTHER AND CHILD. 

solutions to be dropped into the ears of children, the anatomy 
of the parts must be understood. The auditory canal is short 
and the Eustachian tubes are patulous, and solutions dropped 
into such ears of children run directly into the throat. For 
this reason, if for no other, the syringe should not be used. 

Admitted that nothing but pure water has been used, even 
this is too irritating for the ear, Eustachian tubes, and fauces, 
for it must not be forgotten that the mucous membrane or lining 
of the drum or middle ear serves the purpose of the periosteum, 
the same membrane that covers and nourishes the bone. 
Those who have accidentally gotten water up the nose will 
recall its unpleasant irritating effect. 

After scarlet fever, measles, diphtheria, whooping-cough, 
chicken-pox, bronchitis, etc., dentition (cutting teeth) is the 
most fruitful source of running ears, and the tendency of all 
such cases is to recover without damage to hearing, provided 
they be kept clean and nature be given a chance. 

How should the ears be kept clean ? 

We want to impress upon parents, and those who are to ad- 
vise them, the necessity of using the utmost care in the art of 
cleansing the ears of children. Wax (cerumen), with which 
nature has furnished the auditory canal, is usually swabbed out 
weekly, if not oftener, with the twisted corner of a towel, 
handkerchief, or wash-rag soaked with water or soapsuds; 
and more frequently than is supposed a pin or hair-pin is 
called into requisition. By these means the wax is pushed in 
and well rammed down layer after layer, and at each washing 
a layer of desquamating epidermis is added (as cow's hair is 
to the mortar), and this serves to bind the mass together and 
make its removal more difficult. Water and wax will not mix. 

Masses of wax or dried skin — in fact, all sorts of foreign sub- 
stances, pushed into the ear by unsuccessful attempts at 
cleansing with the wash-rag, etc., or foreign bodies designedly 
placed in the ears by children — is often the cause of a most 
distressing cough, for which the little patient is mercilessly 
dosed. " Ear-cough," to the experienced, is quickly recognized 



blSEASES OF THE EAR. 407 

as peculiar and spasmodic, and observant children often com- 
plain of a tickling or irritation in the throat, just below and 
behind the angles of the jaw, which symptom — and perhaps 
accompanying deafness — must point to the ear as a cause. 

Impacted wax, with but few exceptions, is found only in the 
ears of those who have had water, soap and -water, or wet 
cloths used to cleanse their ears from what is usually called 
u dirt," and what we must recognize as absolutely essential to 
perfect hearing and a healthy condition of the ears. Such 
masses must be first soaked by the instillation of a warm 
alkaline solution (baking soda, one teaspoonful to one teacupful 
of warm water) ; these can always be safely removed by syring- 
ing with warm water, which procedure is the only one in which 
we consider the use of water permissible ; even here, however, 
had water not been injudiciously used in the first place the 
wax would never have become packed. 

In case it becomes necessary, on account of superfluous wax 
or the lodgement of dust, to wipe oat the auditory meatus, it 
should be done with a damp towel, or a dry soft cloth, preferably 
a soft greasy rag. We prefer to allow the children to. manipu- 
late the greasy rag, as the size of their fingers just suits their 
ears. 

About Foreign Bodies in the Ear. — Children seem especially 
possessed with a mania for placing buttons, beads, seeds, pebbles, 
etc., into their ears, and the majority of doctors are prone 
to attempt to spoon, gouge, or dig them out. Whosoever 
attempts the removal of any foreign body from the ear of a 
child by any other means than the syringe and warm water, 
and, if the child be frightened, without the use of an anaes- 
thetic, certainly shows great want of experience or heed to 
the warning of those who are able to advise. 

For living insects in the ear pour in oil, or even water. Pref- 
erably oil, even u kerosene." Drown first and subsequently 
remove by syringing. 

Now that we have the petroleum products, — vaseline, cos- 
moline, and fluid cosmoline, — all of which have the charming 



408 MOTHER AND CHILD. 

recommendation of never fermenting, we never order anything 
else to be dropped into the ear ; other oils usually distilled 
must be omitted, because such vegetable products as olive and 
almond oils act, sooner or later, as irritants. 

Except for earache in larger children and adults, we use the 
following preparation, which we designate " earache drops" 
(the aromatics contained prevent the small proportion of 
almond oil from fermenting) : 

Cocaine muriate, two grains ; 
" Baume tranquille," three drachms. 
Put a few drops into the ear with a glass dropper, previously heated 
by dipping in hot water. 

Babies should always wear an under-flannel cap, and larger 
children should wear bonnets during the cold weather, which may 
be made of any warm material to suit the taste. These 
should tie under the chin and protect the ears. Too frequently 
warm caps are worn during the week and to school, while on 
Sunday, as well as on high days and holidays, is substituted a 
gorgeous hat, which leaves the head and ears unprotected. 
Especially necessary is a warm cap for a child who has suf- 
fered from ear-disease. 

On no account should cotton ever be worn in the ears. Why ? 
Because it acts like a cork, prevents the ventilation of the ears, 
and acts only as an irritant. 

A Child with a Running Ear may go out in Cold Weather. — Un- 
less there be actual pain present or commencing inflammation 
of the ears, a child should be warmly dressed and sent out just 
as usual. Housing of children with running ears is more apt, 
by engendering ill health and disordered digestion, to do harm 
rather than good. If the feet are kept dry and warm, fresh dry 
air is to be especially recommended, with out-door exercise. 

Parents cannot be too observant in looking after their chil- 
dren. Apart from the many specific directions given in this 
book, let us ask you to notice the children when they are sleep- 
ing. Is the little one's face in placid repose? Is the mouth as 



DISEASES OF THE EAR. 409 

well as the eyes shut ? If the mouth be open and your child 
not suffering from a recent influenza, it is a " mouth-breather." 
Why a ' : mouth-breather?" Because air does not enter the 
lungs through the upper air-passages. Think of it ! If you 
were to close the child's mouth it would smother. The obstruc- 
tion to breathing must be in the back of its nose, or perhaps 
caused by enlarged tonsils just back of the tongue. What harm 
if it does sleep with its mouth open ? First of all, the mouth 
becomes parched and dry, the teeth and tongue are covered 
with sordes (dried secretions). The arch of the upper jaw, 
into which the teeth are set, from pressure of the upper lip of 
the gaping mouth, is pressed upon and does not develop prop- 
erly. As a consequence, the several portions of the mouth and 
nose become deformed, and the results of chronic inflammation 
of the delicate parts therein contained, by enlargement, induce 
many forms of disease of the ear. The roof of the mouth be- 
comes vaulted. Notice your child at play, and, unlike its 
comrades both in repose and action, the mouth is still open. 
Surely your child's voice has a nasal twang. 

It may be that your child has had several falls or suffered 
a number of injuries to its nose. These in turn will cause 
mechanical obstruction, and make a " mouth-breather" out of 
your child. 

Some children, if not directly after birth, certainly within 
six months, give evidence of nasal and post-nasal obstruction, 
mostly caused by the various forms of adenoid growths which 
have their origin and spring from the posterior wall of the 
pharynx (supra-post-nasal space). For such troubles we must 
invoke the aid of the rhinologist and laryngologist. The " nose- 
man" it is who must exercise his skill. 

After years of experience we are fully satisfied that we are 
but commencing a new era in the treatment, nay, in fact, the 
intelligent comprehension, of most of the diseases of the ear. 
The majority of such cases are not, as is usually erroneously 
supposed, due to some local cause commonly supposed to have 
its origin in the throat, and usually explained as an extension 
s 35 



410 MOTHER AND CHILD. 

of reflected inflammation from the mucous membrane of the 
lungs, pharynx, or nose, but are distinctly traceable to an error 
in the mechanism of the action of the Eustachian tubes and 
their muscles. We are anxious to place ourselves on record when 
we state that eight out of ten cases of aural disease are due to 
nasal obstructions. Unless the aurist be skilled in the treat- 
ment of diseases of the nose, he might as well give up the 
successful treatment of diseases of the ear. This is throwing 
a shell into the camp of the otologist. We throw down the 
gauntlet. His armamentarium of ten years ago must in great 
part be laid aside. About half the instruments used but five 
years ago may be put on the shelf with such curios as the 
bivalve aural speculum, Eustachian bougie, etc. We have but 
to study the function of the Eustachian tube, have in mind its 
condition during the act of deglutition, and critically note the 
effect that mechanical opening or closing of the nostrils will 
have upon the membrana tympani, and in turn the ossicles, — 
in short, the middle ear (tympanum), — and note for ourselves 
the peculiar feeling induced in our perfect ears. Just by way 
of experiment, kind reader, hold your nose closed and swallow ! 
How do your ears feel ? 

We have had particular reference to diseases of the ear in 
infants and children, finding it impossible, in passing, to neglect 
the adult, and have confined ourselves to the study of the 
practical, common-sense treatment, such as hygiene and our 
experience lead us to commend. 

In conclusion allow us to say that, in prescribing for the ear, 
entirely too much guesswork is indulged in, and by waiting 
too much precious time is lost. Do not be hoodwinked when 
a sage tells you that a child will " outgrow" deafness or a dis- 
charging ear. It is recklessness — and this is putting it very 
mildly — for any one to prescribe for an ear without having first 
made a careful ocular examination of it, and those who order 
anything to be dropped into the ear, or order an ear to be 
syringed before making an ocular examination, you may 
depend upon it, are not to be trusted. 



DISEASES OF THE THROAT AND AIR-PASSAGES. Ill 
CHAPTEE XLIX. 

DISEASES OP THE THROAT AND AIR-PASSAGES. 

The diseases which probably cause the most alarm among 
mothers, and justly so, are those which affect the throat ; 
especially when there is the slightest possibility of the dis- 
order being either diphtheria or membranous croup. We pro- 
pose to give in as simple language as possible, so that it can 
be readily understood, a description of these various acute 
diseases of the throat in children, not for the purpose of 
enabling the mother or nurse to make a diagnosis, — that is 
not her business, — but simply to enable her to carry out thor- 
oughly, conscientiously, and intelligently the nursing which 
forms so important a part in the treatment of these diseases. 
Undoubtedly, in times gone by, children suffered very much 
more from croup than they do at present. The change in 
this respect has been brought about by the doing away with 
the short-sleeved and low-necked dresses of children, and 
the thorough understanding of the fact that in a climate as 
changeable as ours the whole surface of the body, from the 
neck to the feet, should be protected from the sudden chilling 
of the surface by wearing a garment, be it ever so thin, of 
either wool, or wool and silk mixed, the year round. 

We hear a great deal of diphtheria, and it is well for us to 
understand what is meant by this term. The word has been 
applied to a disease which is characterized by a deposit upon 
the throat, and, consequently, every time a deposit is noticed 
upon a child's throat it is at once thought to be diphtheria. 
The uneducated but avaricious (so-called) " doctor" applies the 
term diphtheritic to all mild and readily-curable affections of 
the throat, to his advantage. What really constitutes this 
dreaded disease is a profound constitutional poisoning, caused 
by exposure to sewer-air, polluted water or milk, exposure from 



412 MOTHER AND CHILD. 

contagion of the same disease, by which the system is pro- 
foundly poisoned with the local trouble, manifesting itself in 
the throat, larynx, or air-passages. A child may have diph- 
theria without any appearance of membrane in its throat ; then 
again deposits may be found on the tonsils, as in quinsy, which 
is not diphtheria at all ; but, for the sake of caution, children 
affected with sore throats should be isolated until seen by the 
doctor. Those who are well should not use the same spoon or 
drinking-cup as those that are ailing; this applies to adults 
as well as to children. 

There are mild forms of diphtheria, affecting adults, during 
which the constitution is not sufficiently affected to prevent 
their going about their daily avocations, and such individuals 
are beyond a doubt the means of carrying contagion to those 
with whom their breath comes in contact. There is no doubt 
but that many times diphtheria, and other diseases even worse, are 
carried to children by the foolish and useless practice of kissing to 
which the poor little ones are subjected. It seems strange that a 
child who will be protected most energetically from draughts, 
from every form of open contamination, will be permitted to 
come in direct contact — the most thorough means of propa- 
gating contagion — with diphtheria, whooping-cough, scarlet 
fever, and worse, by kissing. We dwell upon this, because we 
feel that parents should instruct their nurses to prohibit chil- 
dren being kissed by other children and by strangers. 

A sore throat should always be looked upon with suspicion 
in a child, and carefully treated : and especially if the child's 
neck is swollen on the outside, the glands enlarged, should 
there be a coated tongue, offensive breath, and great prostra- 
tion. No one should attempt to treat a case of this kind 
without immediately consulting the doctor ; it is a recognized 
fact that should by chance the little patient have been ex- 
posed to sewer-air from a defective stationary wash-stand in 
the bedroom, or from the bath-room or closet, a simple catarrh 
of the throat from cold will allow the diphtheritic germ, or 
whatever the poison may be, to be engrafted upon it or be 



DISEASES OF THE THROAT AND AIR-PASSAGES 413 

absorbed into tbe system, and the only means of counteracting 
its influence would be the most active local treatment to the 
throat, and placing the child upon stimulants and medication 
that will strengthen it. 

Whenever a child complains of a sore throat and there 
seems to be redness of the throat inside, or the- tonsils become 
swollen and the child complains when swallowing, has a cough, 
it is always safe and indeed a proper thing to spray the throat 
and nose with some mild solution that will at once cleanse 
and soothe it. This will never interfere with the doctor's 
treatment, and can be done before the doctor comes. The 
best forms of atomizers that we know of, and one of which 
should be in every household, are the Davidson small hand 
atomizer and the Burgess atomizer, which are valuable for 
spraying the throat and nose, and that of Oliver, a more 
expensive one, but the very best so far made for inhaling 
lime-water or such substances as are used in cases of croup. 
A solution known as " Dobell's solution" can be used in these 
cases ; also in cases of whooping-cough, or in all forms of sore 
throat. 

There are many diseases of children that are accompanied by 
sore throat, or sore mouth, which require constant cleansing 
of the mucous membrane, or the deposit, or mucus, will accu- 
mulate, become offensive, or finally, as in diphtheria, become 
putrid. Great attention should be paid to the slightest throat- 
ailments of children, because an irritated throat is often an 
opening for the entrance of infectious disease. 

A child complaining of difficulty of swallowing should under 
no circumstances be allowed to go out of doors, especially if 
the weather is damp or at all raw or cold. The throat should 
be gently sprayed with the solution just mentioned, and some 
counter-irritation made to the outside, using St. John Long 
liniment, or simply rubbing with vaseline, sweet oil, or cod-liver 
oil. If the child's voice is slightly muffled in speaking, if it 
speaks through its nose, should there be tenderness upon press- 
ure and slight enlargement of the glands under the angle of 

35* 



414 MOTHER AND CHILD. 

the jaw, on one side, and the attack come on suddenly (in an 
older child with a chill or high fever), the probability is that the 
attack is one affecting the tonsils, — one of quinsy. The house- 
hold remedies to be used in such a case would be a fever-drink 
of two teaspoonfuls of spirits of Mindererus (liquor ammonias 
acetatis), one teaspoon ful of sweet spirits of nitre to half a 
glass of water, sipped at frequent intervals, for a child about 
five years of age. The feet should be put in a hot mustard- 
bath and the stockings kept on afterwards, the throat sprayed, 
the child allowed small pieces of cracked ice ; the food for at 
least twenty-four hours should consist of beef-tea or chicken- 
broth, or probably still better, if the child will take it, milk 
and lime-water, or Yichy water, half and half. In all these 
acute throat-troubles of children we have found the early appli- 
cation of a handkerchief wrung out in cool water, tied round 
the throat like a cravat and covered by oiled silk, of very 
great service. This treatment will often avert an attack of 
croup. Throat-troubles in children are by far too serious to 
allow any time to elapse before receiving the most thorough 
treatment ; when a child complains, it is far better to send at 
once for the doctor. 



CROUP. 

There are some children who are particularly liable to 
croup : it seems a family characteristic. Boys are more apt 
to have it than girls, — possibly because they are more ex- 
posed; indeed, the tendency to "harden" children by letting 
them go barelegged, or with low necks and short sleeves, will 
sooner or later bring either a bad attack of croup, or bronchitis, 
as a consequence. Children who go constantly, as do many 
of the poor, without shoes or stockings are not as apt to con- 
tract these catarrhal diseases as those who temporarily have 
their feet exposed to cold, sudden changes, or dampness ; but 
the child who is overdressed will perspire and be as liable to 
attacks of croup or bronchitis as one who is insufficiently 



DISEASES OF THE THROAT AND AIR-PASSAGES. 415 

dressed. What is ordinarily known as croup is that affection 
which comes on suddenly at night, accompanied by a dry, 
ringing cough, difficulty in breathing, and all the evidences of 
threatening suffocation, without any marked previous symp- 
tom. It usually occurs at night. The child will wake from sleep 
with all the symptoms that are most terrifying. Its evident 
spasmodic character has given it the name of spasmodic croup. 
It may be the result of cold or of an overloaded stomach, and 
children who are subject to this affection should not be 
allowed heavy suppers. 

Although the breathing is greatly interfered with during 
this attack, the sounds are ringing, the cough sonorous and 
brassy and loud ; this is an important matter, as it shows 
there is no deposit of membrane to muffle the sound. The 
treatment of such a case should be as follows : a sponge 
wrung out in water as hot as can be borne by the child 
should at once be tied round the throat, and kept there by a 
towel, or, better, oiled silk or rubber sheeting ; the feet and 
legs as far as the knees should be immersed in a hot bath con- 
taining a few teaspoonfuls of mustard flour, and be kept in 
the water for at least fifteen minutes, then thoroughly dried, 
and a pair of stockings put on. The child should be given a 
half-teaspoonful or a whole teaspoonful of syrup of ipecac, — 
the latter if the child is over four years of age, — followed by 
a drink of water every fifteen minutes until it vomits ; after 
which the spasms will cease, and the child will turn over from 
exhaustion and sleep the remainder of the night. A powder 
of half sugar and half alum, given in teaspoonful doses or 
given with the ipecac, will hasten its emetic action. If the 
child is anxious and restless after the attack of croup has 
subsided, sleep seems impossible, or some cough still remains, 
for a child from a year and a half to two years old, ten 
drops of paregoric in a teaspoonful of glycerin, repeated in an 
hour, will have a quieting effect, or ten drops of sweet spirits 
of nitre in a little sugar and water can be given every half- 
hour or hour until the child is quiet. If the bowels have 



416 MOTHER AND CHILD. 

not been moved during the day, or are constipated, an injection 
of warm suds will frequently bring relief. 

Possibly after a good sleep the next day the child will be in 
ordinary health, without any marked evidence of exhaustion 
from the attack of the previous night; or it may droop 
slightly, have an occasional cough which is rather ringing, 
or the appetite may be impaired. If such is the case, it 
would be well to give the child a dose of castor oil, and by 
all means keep it in the nursery. If the child is over a year 
old, give it from five to ten, or if three years old, fifteen, 
drops of the aromatic spirits of ammonia, every three hours. 
If children who have a tendency to hoarseness and croup 
have their feet washed in cool water every night before 
retiring, they will often escape an attack. It should also be 
borne in mind that it is not essential that a child should have 
a bath every day, as some mothers believe ; if the weather is 
damp or raw, and the child at all drooping, the surface should 
be quickly sponged with salt water, simply for cleansing, 
and the circulation increased by thorough rubbing with a 
soft towel. We think if the custom — which seems to be a 
cast-iron one with many mothers — of bathing children every 
day and taking them out in all kinds of weather were occa- 
sionally discontinued, there would not be so many sick children. 

MEMBRANOUS AND DIPHTHERITIC CROUP. 

There is no disease more appalling, or that seems more 
strenuously to resist all efforts at successful medical treat- 
ment, than that form of croup which is accompanied by 
thick mucus in the air-passages of the larynx, or by diph- 
theritic membrane. When speaking of diphtheria we dwelt 
upon the fact that it is a constitutional blood-poisoning which 
may exist without the presence of membrane in the throat, 
and also that the membrane, when it does exist, need not 
be limited to the portions of the throat that we can see, 
but may extend over the whole surface of the mucous mem- 
brane down to the lungs and upward into the nose; indeed, 



DISEASES OF THE THROAT AND AIR-PASSAGES. 417 

when it does so, it clings firmly to the mucous membrane, 
leaves a raw surface when detached, and if allowed to remain 
acts as an obstruction to the entrance of air, or decomposes, 
becomes putrid, and in this way acts still farther as a poison. 
For these reasons the spraying of the throat with an alkaline, 
antiseptic solution, such as Dobell's solution, which softens 
the membrane and prevents its decomposition, has been recom- 
mended in the most trivial throat-complaints as a precau- 
tionary measure while waiting for the doctor. 

Membranous croup is recognized to be of two varieties, — 
one the result of catarrh, when the obstruction is caused by 
very thick mucus in the larynx, which may become tenacious 
like membrane, and the other due to the deposit of diphtheritic 
membrane, which may be found in connection with the deposit 
in the other parts of the throat, or may be simply limited 
to the air-passages. A child with membranous croup will 
probably be ailing for a few days; its cough will at first be 
croupy, its voice will become husky; the cough will cease, 
or nearly so; the breathing will become labored, and, finally, 
wiH be plainly heard at a distance. The child will show by 
its movements that there is narrowing of the passage in its 
larynx ; the nostrils will dilate with each inspiration ; the 
child will breathe with its mouth open ; it will desire to sit 
up, so as to get all the air possible ; the lips will become 
blue, owing to the interference with the circulation ; the child 
will become anxious, restless, appealing to every one around 
it for relief; it will refuse food, but will drink water in sips. 
If the obstruction continues or increases, the extremities 
become cold, the pulse rapid and at times irregular; and 
finally, if nothing is done for the relief of the child, it will 
gradually die of asphyxia, or a sudden shutting off of the 
supply of air. 

A peculiarity of the breathing in obstruction of the larynx 

is the contraction, or sinking in, of the lower portions of the 

ribs, or pit of the stomach or epigastrium (in health these 

parts expand), and the marked depression, or sucking in, of 

bb 



418 MOTHER AND CHILD. 

the lower portion of the neck, just above the breast-bone. 
But probably eight cases out of ten of membranous croup 
with which one comes in contact are due to a diphtheritic 
blood-poisoning, which we may attribute, in our larger cities, 
to defective stationary wash stands in the sleeping apartment 
or nursery, absolutely conveying the most poisonous form of 
sewer-air from a bad cesspool or drain directly to the infant's 
room. One should never rest assured that the trap of the 
bath-tub, or its overflow, is secure, or that of the stationary 
wash-stand in the child's nursery or sleeping apartment ; these 
should be banished to an adjoining room, where they may have 
free communication with the fresh air,' and should be well 
supplied with some form of disinfectant, as Labarraque's solu- 
tion. But then, again, a child with a slightly sore throat 
may be exposed to the gases coming from an open sewer, 
or to the air supplied to a furnace, which is passed over 
putrefying matter, or to stagnant water in the cellar ; to the 
breath of one convalescent from the disease, or who has it in 
a mild form (communicated by kissing). In addition to these 
causes, milk-, when mixed with water which has been contam- 
inated by sewage, has been known to produce this disease. 
For the«e reasons the catarrhs, especially of the croupy kind, 
however slight, should be attended to at once in children, as 
they constitute a point of entrance of the diphtheritic poison 
into the system ; and as children over a year old are very 
much more subjected to the sudden changes that produce 
these catarrhs, all forms of membranous croup are more apt 
to take place at that time. 

Let us dwell for a few moments upon the nursing of such 
cases. There are two facts most important to bear in mind as 
causes of death : the one, the interference with the entrance 
of air into the larynx or air-passages ; the other, the poisoning 
of the system and the weakening of the heart which accom- 
pany diphtheria, and cause the patient to more readily succumb 
to the influences of deficient aeration. 

If a child has a croupy cough during the day, with rapidity 



DISEASES OF THE THROAT AND AIR-PASSAGES. 419 

of breathing and slight fever, no time should be lost in influ- 
encing the mucous membrane, establishing secretion, and thus 




giving relief. The child should be kept in its nursery ; and we 
may say that in all cases of bronchitis or pneumonia, and even 
croup, when it has to be lifted constantly from its bed, or cannot 



420 MOTHER AND CHILD. 

be comfortable for any length of time in one position, the child 
should have a long flannel wrapper, extending much below its 
feet, that can be opened in front and at the back, with high neck 
and long sleeves. It is absolutely necessary that the air of the 
nursery be not only pure but warm, the temperature about 80° 
F. The air should also be moist, and for this purpose some ar- 
rangement must be made to have a constant supply of steam ; 
this can be done by placing a kettle on the stove, if there is one 
in the room, or if not, by using a teakettle with a lamp under 
it. If the case seems to be one of more than an ordinary slight 
cold, no time should be lost in causing the vapor of an alkali 
to come in contact with the mucous membrane, and there 
is none better for this purpose than that which comes from 
slaked lime. Lime can be placed in a bucket beneath or beside 
the child's crib, and the crib covered over with a sheet in the 
form of a tent, allowing the vapor to accumulate within. If 
the child is only satisfied when on the mother's lap, the vapor 
can readily be brought in contact with it by throwing the sheet 
over the bucket and extending it over her own shoulder. The 
advantages of the vapor from lime are its moisture, its warmth, 
and its alkalinity ; and if membrane should form in the throat, 
lime-vapor honey-combs it the same as lime-water does the curd 
of milk. The Arnold steam-sterilizer has fitted to it an arrange- 
ment for conveying the steam, in such cases, to a canopy placed 
over the crib to form a tent. An excellent and ingenious de- 
vice for domestic use that we saw recently consisted of an um- 
brella opened over a baby-carriage, in which the child was placed, 
and the whole covered with a sheet. The steam was con- 
veyed by a long piece of rubber tubing attached at one end to 
the spout of a teakettle placed on the coals in an open grate. 
If the child seems to suffer very much from the obstruction, — 
that is to say, if the breathing becomes rasping, — the spray from 
an atomizer (and a steam one is much to be preferred) should 
be used constantly; or if the child is old enough, it can probably 
for several minutes at a time inhale the vapor from the Oliver 
vaporizer. The solution to be employed in these cases is one- 



DISEASES OF THE THROAT AND AIR-PASSAGES. 421 

half lime-water and one-half Dobell's solution, or if two vapor- 
izers are in use, as should be the case, so as constantly to have 
some form of steam inhaled, one solution should be of turbid 
lime-water, made by adding a teaspoonful of liquor potassce to 
two ounces of lime-water. Early treatment in these cases 
is so important that we do not hesitate to suggest that the 
mother or nurse, if she cannot get the advice of a physician 
at once, should lose no time, but place the child under the 
following treatment until the doctor arrives. 

If the child's croupy cough or hoarseness should continue 
during the daytime, even after the hot foot-bath and the warm 
applications to the throat (flannel wrung out in hot vinegar 
and water and covered by oiled silk), the following fever mixt- 
ure, which will possibly also loosen the cough, should be given 
until the doctor's arrival : 

Solution of acetate of ammonium, one ounce and a half; 
Solution of citrate of potassium, one ounce ; 
Compound syrup of squill, one drachm ; 
Simple elixir, sufficient to make three ounces. 
A dessertspoonful in water every two hours for a child of two years. 

Should it be impossible to get a doctor (and only in such 
event, for the matter is a serious one), the administration 
of an emetic may be important if suffocation seems immi- 
nent. If the child struggles for breath, if its face becomes 
bluish, its extremities cold, and the other signs of which we 
have spoken exhibit themselves, a half-teaspoonful of alum, 
with the same quantity of powdered sugar, or given with 
water, will be the safest emetic. A harsh emetic, such as 
ipecac, may disorder the stomach without a correspondingly 
good effect ; indeed, may increase the debility, and should not 
be given without the doctor's advice. In addition to this, a 
child of over a year should, take, at least every hour, five 
drops of the aromatic spirits of ammonia, in water. 

Warmth and moisture should be applied to the chest and 
throat. Some physicians recommend the use of a material 

36 



422 MOTHER AND CHILD. 

that will readily absorb large quantities of liquid ; a mass of 
lint or folds of flannel or a sponge, soaked in warm water 
(wrung out to prevent its dripping), may be connected by 
shoulder-straps and tapes at the side, placed on the front and 
back, and covered with oiled skin ; this should be changed 
about twice a day or oftener. Care should be taken when the 
change is made ; it should be done by placing the hand beneath 
the wrapper, and without exposing the child's chest at all. 
Others prefer ordinary flaxseed poultices, made in the same 
way. Our own preference is for two flannel bags filled with 
hops and quilted ; these can readily be attached by safety- 
pins on the outside, and thus kept in place ; oiled silk can be 
stitched on to each one, so as to prevent evaporation, and 
these bags can either be wrung out in water or some soothing 
or stimulating liniment, as the occasion requires. 

The child's diet must be carefully attended to. It should be 
encouraged to drink freely of milk and lime-water or Vichy 
water, chicken-broth or beef-tea, or, if it prefers it, small 
quantities of beef-juice, or beef extract or peptonoids. Wine- 
whey, in cases where there seems to be debility, is absolutely 
essential ; or a teaspoonful of port wine, whiskey, or brandy, 
in water, should be given every three or four hours. Pep- 
tonized milk is a most valuable article in such cases, and if 
there be difficulty in swallowing, the nourishment may be 
given in this form by the bowel. The peptonizing -tubes can 
be had, with full directions for their use, at any drug-store. 

In regard to the feeding of sick children, absolute regularity 
and accuracy must be observed in their diet. The food should 
be of the most nourishing character, requiring least digestion, 
and in as small bulk as possible. There should be a schedule 
kept of the exact amount, and when given, so that the doctor 
may judge as to whether the child needs more or less in 
the twenty four hours. In some diseases, such as diphtheria 
and typhoid fever, the child's life depends on this systematic 
nourishment. In the latter, the dietetics form the most im- 
portant consideration, because for a long period (at least 



DISEASES OF THE THROAT AND AIR-PASSAGES. 423 

three weeks) the child's life is to be sustained by a diet so regu- 
lated that it will give all possible nourishment and at the same 
time not unduly stimulate the moving of the bowel or act as 
an irritant to those portions which are already inflamed or 
ulcerated. In the nursing of diphtheria, the most important 
points to bear in mind are, first of all, that it is a disease capable 
of being greatly modified by careful treatment and nursing ; 
that it is directly contagious by means of contact with the 
membrane ; that systematic nourishment and stimulation are 
absolutely essential. 

Indeed, all continued croupy coughs should be looked upon 
as. serious, even should no evidences of diphtheria be detected 
in the throat. Eecently the great facility with which a tube 
can be introduced through the mouth into the larynx has been 
demonstrated, with the result of a great saving of life. It is 
an operation devoid of the horrors attendant upon opening 
the trachea, and can be made use of very early in the case, 
before the child is exhausted and the air-passages are filled 
with membrane or thick mucus. 

Whether due to diphtheria or not, the treatment and nursing 
of membranous croup are practically the same. A child suffer- 
ing from this disease should have its throat washed and sprayed 
frequently with an antiseptic cleansing solution, such as Do- 
bell's solution or listerine, twenty drops in an ounce of water, in 
order to prevent decomposition of the membrane ; the air that 
it breathes should be pure, and at the same time charged with 
those materials that soften the membranous deposit and pre- 
vent its putridity. For this we have the vapor of steam con- 
taining lime, the products of tar, carbolic acid, or chlorine ; 
but as we have gone over this matter thoroughly when writing 
of scarlet fever, it will not be necessary to repeat it here. 



424 MOTHER AND CHILD. 



CHAPTEE L. 

WHOOPING-COUGH. 1 



"Whooping-cough alone does not cause such a large mor- 
tality : it is fatal in its complications. In other words, being 
a disease that lasts six weeks, or sometimes two months, 
parents or nurses become careless and the babies die from 
debility, pneumonia, bronchitis, bowel-complaint, or some com- 
plication caused by the great straining induced by the cough. 

Let us for a moment study the nature of this disease from 
the most recent investigations of the subject. It has been 
well known and thoroughly described by medical writers for 
many years; certainly for over three hundred years it has 
been acknowledged as a contagious affection, not simply a 
nervous cough. 

It is a disease usually occurring in childhood, but is limited 
to no particular age. We once saw a child who had it at birth, 
undoubtedly, and we frequently hear of it at the age of sixty 
or over. It is rare for a person to have it twice. It begins 
as an ordinary cold, though, after the child has had apparently 
a cold in its head and a dry cough for some days, the cough 
comes on in paroxysms, usually upon taking food, or following 
excitement ; but the child tries to suppress the cough, and in 
doing so the face becomes much congested. Soon the paroxysm 
of coughing will provoke vomiting, and then the whoop, or draw- 
ing in of the breath,, after several forcible expulsive coughing- 
spells have taken place. These paroxysms increase in force 
and frequency ; the child's face becomes blue and puffy ; the 
little sufferer seizes on the nearest object for support; the 
spells are agonizing to behold ; finally, after successive cough- 

1 This chapter appeared, as an article by Dr. J. M. Keating, in Babyhood 
for September, 1886, and is republished by permission of the publishers. 



WHOOPING- CO UGH 425 

ing-spells, each followed by a gasping which produces the 
whoop, a violent attack of vomiting takes place, mucus runs 
from the mouth and nose, and the child falls back limp and 
exhausted, in a few moments to resume its play, without any 
evidence, except the puffing about the eyes, of any trouble in 
the respiratory tract. These are the characteristic features of 
the disease. 

It is impossible at first to make a definite statement as to 
the existence of the disease; it is only after the first week or 
ten days, when the cough assumes the features above described, 
that one is certain ; and especially is this the case if the child 
has been exposed to the disease. It is not the most contagious 
malady of childhood. — not nearly as much so as measles, 
chicken-pox, or scarlet fever; it requires, in all probability, 
either the breath direct from another case, or inhaling the air 
of a crowded room or car in which a child with the disease 
has been. 

In the article on scarlatina what is meant by the period of 
incubation is explained, — that time which elapses between the 
direct exposure to the poison of a disease, or the absorption 
of its contagious principles, and that of the appearance of the 
first symptoms. For whooping-cough this is about two weeks, 
as nearly as we can calculate it. 

The disease is a contagious one, — that we all know. Its 
contagious material resides undoubtedly in the breath of the 
one affected with it ; it is probably taken up by the air during 
its passage over the secretions from the throat and nose. The 
air probably retains it for a long time, and these secretions 
usually, at the height Of the disease, being excessive, are easily 
communicated from one child to another in play, by kissing, 
etc.. or they dry, are finely pulverized, and are scattered 
throughout a badly-ventilated room. During the whole period 
of excessive secretion, from the first week till the cough 
almost disappears, the child with whooping-cough is capable 
of giving the disease to others with whom it comes in contact. 

It is almost criminal, then, for parents and nurses to take these 

36* 



426 MOTHER AND CHILD. 

children into open squares or parks {places of amusement) where 
healthy children congregate. And yet this is done daily. 

Investigators have detected by the microscope certain germs 
— which have since been found in all cases of this disease — in 
the sputum and in the secretions from the nose. In all pro't a- 
bility these come in contact with the mucous membrane, are 
directly absorbed, multiply and diffuse themselves through the 
blood during the period of incubation, or act in some way es- 
pecially upon the delicate membrane of the nose and respira- 
tory tract. Animals have been inoculated with this mucus 
and have exhibited all the symptoms of the disease. 

It is a disease that runs a regular course of its own, if 
not treated. In Japan it is called the "hundred-day disease." 
It usually, in mild cases, lasts about two months, possibly 
sometimes three, though active treatment and careful nursing 
will shorten it to a very great extent, or make it very much 
less severe. 

It is not expedient here to examine carefully the medical 
treatment of this disease. As far as known, no drug will at 
once cut short an attack, but the physician has many re- 
sources at his command that will mitigate its severity, diminish 
the intensity of its paroxysms, and lessen the great liability 
to hemorrhages, to heart-disease, to disease of the lungs, whose 
delicate tissue is easily damaged by forcible coughing ; and it 
is for him to decide what is especially advisable for each par- 
ticular case. He will probably give the child belladonna or 
quinine, or possibly recommend an infusion of chestnut-leaves. 
At night he may find it necessary to give the bromides of 
potassium or ammonium, with chloral. 

To the mother belongs the equally important duty of 
warding off danger by careful nursing, by guarding her child 
against exposure, by proper clothing, careful and nutritious 
diet, and abundance of fresh air. 

Every child with whooping-cough should have pure, fresh 
air, and be out of doors as much as possible in suitable 
weather. The sea-air, when accessible, is greatly to be de- 



WHO OP J NO- CO UGH. 42 7 

sired ; the moisture in it, and possibly the salt, help to liquefy 
the secretions. It has a sedative effect, allaying nervous irri- 
tability ; then it is always fresh and pure, and this is most im- 
portant in the treatment. The fresh air prevents debility, 
and therefore wards off those serious complications due to 
"run down" and loss of appetite. If the patient is obliged to 
remain in the city, it is well to dress the child warmly, make 
a play-room of the top story of the house, and open the 
windows to insure a constant access of fresh air, purer than 
that directly from the street. 

Diseases of the lungs are most to be dreaded as a complica- 
tion; therefore all children suffering from whooping-cough 
should have some woollen garment, light in summer and 
heavier in winter, covering the entire body. It is a mistake 
to clothe children too warmly; active perspiration during 
play will only invite colds should the child be exposed to a 
draught. Indeed, this is the case with all children, sick or 
well. Often severe catarrhs are brought about in children 
who are overclothed. 

A child should be accustomed to a daily bath or sponging 
in cool water; its chest, back, and feet should be thoroughly 
.sponged, and then reaction brought about by a good rubbing. 

There is a curiously close relationship between the feet and 
the mucous membrane of the air-passages. We all know how 
quickly wet feet, when exposed to draughts, will give a 
catarrh. A foot-bath of cool or cold water at night will do 
much to lessen the liability to colds. 

A child with whooping-cough should receive a full supply 
of digestible, nutritious food : gruels, soups, or broths ; Mellin's 
food; a light dinner of chicken or steak, if it is old enough, 
with vegetables, such as well-cooked young beets, spinach, cauli- 
flower, roasted or mashed potatoes, and stewed fruits, as 
apples or peaches, that will keep the bowels regular. Milk 
should, of course, be plentifully used, and it is well to dilute it 
with lime-water, or Yichy water, to prevent it curdling in 
heavy masses. A child is apt to have a paroxysm and vomit 



428 MOTHER AND CHILD. 

a meal just after it is taken. Some light, nourishing food 
which will be retained should at once be given ; either a cup 
of broth with barley, or milk and lime-water, or some sherry 
and water with sponge-cake, will serve the purpose. 

We have, often noticed that a copious discharge of thick 
mucus follows a paroxysm, and that until this discharge 
takes place the cough will be repeated. The mother should 
recognize this fact and do all in her power to aid the child. 
In the case of an infant this can be accomplished by turning 
the child over on its stomach, with the head low, and detach- 
ing the mucus from the mouth with her finger. If the child 
is older it should be taught to blow its nose thoroughly, or 
probably by inducing vomiting at once relief will come and 
the paroxysm be cut short. A child can be very materially 
aided in this way and the severe strain avoided. 

A large amount of the thick mucus which cannot be gotten 
rid of by the cough may seriously threaten suffocation. In 
such a case a teaspoonful of syrup of ipecac, or the same of 
powdered alum mixed with syrup, should be at once given to 
provoke immediate vomiting. 

Counter-irritation to the chest by means of various lini- 
ments is certainty valuable; a suitable one will be selected by 
the physician, containing possibly the oil of amber, croton oil, 
or turpentine, in soap liniment, or possibly chloroform lini- 
ment. Our own experience has taught us that the spray 
from an atomizer is a valuable aid in the treatment of this 
disease. It can be used to make the thick mucus more watery, 
and also as a means of carrying medicaments directly to the 
surface. But it requires an immense amount of patience on 
the part of the mother. The nose and throat should receive 
in this way a thorough treatment five or six times a day. 
The nose should be frequently cleansed by the spray of 
Dobells solution (carbolic acid, borax, soda, and glycerin). 

Whooping-cough is a distinct disease, with a history of its 
own, and belongs to the same category as the other conta- 
gious affections of childhood. We have avoided discussion of 



FEVER. 429 

its medical treatment ; that belongs to the doctor. Whatever 
tends to weaken the child invites most serious complications, 
and these are the causes of the great mortality mentioned. 
All patent nostrums of uncertain combination, or of such com- 
position as to derange the secretions, produce constipation, or 
cause loss of appetite, are to be avoided by all means. Good 
nursing is more than half the battle. Fresh air, proper cloth- 
ing, good, nutritious diet, regulation of the bowels, efforts to 
mitigate the intensity of the paroxysms by aiding the child in 
discharging the mucus, giving it an easy and comfortable posi- 
tion which relieves the strain, supporting it for the same pur- 
pose, pressure of the hand over the eyes to prevent their 
strain, — all these are as important as the medical treatment. 



CHAPTEE LI. 

FEVER. 



It is well to make a few remarks upon the subject of fever, 
as mothers are often much worried at the symptoms of 
heightened temperature, and are frequently at a loss to know 
what to do until the doctor arrives. Fever is a symptom : it 
may be initiatory of any of the diseases of childhood, or it may 
be an evidence of indigestion, or of the retention of poisonous 
matters, usually called biliousness ; nevertheless it is only a 
symptom, and it is necessary to be cautious in our treatment 
of it until we know its cause. 

We are greatly opposed to that smattering of medical knowl- 
edge which justifies the adage, " a little knowledge is a dangerous 
thing," — dangerous, because it either makes one careless when 
confronted by the greatest though concealed danger, or over- 
confident and rash when caution and experience are most re- 
quired. On this account we have always kept fever thermom- 
eters away from mothers ; suffice it for them to know by touch 



430 



MOTHER AND CHILD. 



Fig. 37. 



and general symptoms that their child has fever, and then let 
them send for the doctor and give him the sole control and re- 
sponsibility of the case. But circumstances may arise when the 
registration of a temperature is important, and on that account 
we will speak of it here. The ordinary fever thermometer is 
represented in Fig. 37. The thermometer is a deli- 
cate instrument, and requires care in handling. Be- 
fore using it, the detached black line or register 
should be below the arrow, or mark of normal heat. 
With children old enough to understand that it is 
not to be chewed, the temperature is best taken 
under the tongue, with the lips holding the ther- 
mometer, and it should remain there for two min- 
utes. With younger children, the armpit is the 
place usually selected, care being taken to hold the 
arm tightly across the chest and to keep the part 

Fig. 38. 




covered. With babies, we prefer the groin or the bowel. If 
introduced into the bowel the end must be held on to firmly, 
and care taken that in introducing and withdrawing it the 
instrument is not broken. 

The record should be noted, the register being shaken back 
into its place below the normal mark (the arrow). To do this, 
take the thermometer by the upper part, not the bulb, with 
the whole hand grasped about it, bulb end uppermost, and 



FEVER. 431 

then swing the arm from the shoulder forward with some force. 
The thermometer should be carefully wiped with alcohol or 
cologne before putting it away. 

It is a great mistake for a mother to constantly take the 
temperature of her child for curiosity's sake ; it only unnerves 
her, and renders her less capable of exercising proper judgment 
during its illness. The doctor will manage that part of the 
case, and he alone is capable of attaching due importance to 
the readings. 

To return to our subject. A child is languid, refuses to play, 
its head is hot, the skin is dry ; in other words, it is feverish. 
Its face is flushed, it is irritable, or possibly drowsy, or it may 
be unduly excited. What should the mother do ? It may be 
indigestion ; it may be biliousness ; it may be one of the eruptive 
fevers coming on. Put the child to bed at once, after giving 
it a hot foot-bath, to which a little mustard (a teaspoonful 
to a basin of water will suffice) is a good addition. Give it 
half milk and half boiling water, if it craves drink and needs 
nourishment ; keep light covering over it, and prepare a drink 
consisting of a tumbler of water, a teaspoonful of sweet spirits 
of nitre, and two teaspoonfuls of spirits of Mindererus, to be 
taken at intervals, if it is thirsty. Some children crave pure 
water when feverish, or weak lemonade with but little sugar; 
if so, let them have it. Water in fever, internally and ex- 
ternally, we now know to be the best thing, and we look back 
with pity upon the sufferings of those poor creatures who were 
refused it most emphatically not many years ago. If the 
fever increases, and the child becomes restless, hot. delirious 
even, sponge it off with water that feels slightly cool to the 
hand, and to which has been added cologne, alcohol, or vinegar. 
This sponging should be done every hour or two, the child 
protected carefully from draughts, and each part properly 
covered after it has been sponged ; even should the attack be 
one of an eruptive fever it will do no harm but much good. 
Keep the head cool in the same way. If the doctor does not 
come within a few hours, look at the tongue ; if it is coated, 







432 MOTHER AND CHILD. 

dusty-colored towards the centre and back, give the child of 
one year or older a tablespoonful of solution of soda mint and 
a teaspoonful of spiced syrup of rhubarb, and in an hour or so 
an enema of warm water and sweet oil. If the belly seems 
distended, add a teaspoonful of the tincture of assafoetida to the 
enema. Next morning, when there is a good light, examine 
the body for an eruption ; if you find on the neck and chest 
a uniform rash, if the tongue is red on the edges, if the throat 
is red, and possibly the child has been nauseated, or indeed 
has vomited, you have a case of scarlet fever to deal with. 
But the chances are that your anxiety will be allayed by the 
subsidence of the symptoms ; the bowels will move copiously, 
the passage consisting of bilious, slimy matter, or the child 
may vomit some undigested material, break out in a profuse 
perspiration, and fall asleep, to awake bright and well. If 
so, diet well for a few days ; keep to soups and broths ; avoid 
solid food and too rich milk ; or you may find that the 
throat — with a few white flakes like curds on the tonsils, 
which so frightened you and caused you rightly to send for 
the doctor at once and to urge haste — has lost the red, angry 
look and deposit under the judicious treatment by a laxative, 
preferably calomel and soda, and spraying with Dobell's solu- 
tion, which he instituted. These sudden fevers, together with 
throats like this, look surprisingly like diphtheria, and cause 
just alarm, though they are probably only the result of indi- 
gestion. Some cases of diphtheria start in this manner, and 
as we cannot at the outset distinguish between them, the 
utmost care in treatment is required. 



FA MIL V MED J CINE- CHES T. 



433 



LIST OF ARTICLES FOR THE FAMILY MEDICINE-CHEST. 



Castor oil. 

Aromatic syrup of rhubarb. 

Distillate of haniamelis. 

Paregoric. 

Laudanum. 

Sweet spirits of nitre. 

Spirits of Mindererus (liq. amnion, ace- 
tatis). 

Aromatic spirits of ammonia. 

Chlorodyne. 

Brown's essence of Jamaica giuger. 

Soda-mint tablets. 

Valentine's or Wyeth's meat extract. 

Benzoated oxide of zinc ointment. 

Cold cream. 

Vaseline (white preferred). 

Court plaster. 

Adhesive plaster (rubber). 

Roll of carbolated antiseptic gauze 
(Johnson & Johnson). 

Sulphonal, five-grain compressed tablets. 

Bromide of potassium, five-grain com- 
pressed tablets. 

Phenacetin, five-grain compressed tab- 
lets. 

Chloride of ammonium, five-grain com- 
pressed tablets. 

One dozen compressed tablets, each one 
containing one-sixth of a grain of cal- 
omel and two grains of bicarb, of soda. 

Tincture of iodine. 

Syrup of ipecac. 

Essence of peppermint. 

Tincture of assafoetida. 

Mustard leaves (two strengths). 

Belladonna plaster. 



Subnitrate of bismuth. 

Alcohol and a lamp. 

Syringes for enemas, one a fountain, and 

another of hard rubber, holding two 

ounces. 
St. John Long liniment. 
Medicine-dropper. 
Graduated medicine-glass. 
Compressed tablets of tincture of aconite, 

one minim each, for fever. 
Bicarbonate of sodium. 
Glycerin suppositories, put up in tin-foil 

or waxed paper and in a glass-stoppered 

bottle. 
Dobell's solution and Burgess's atomizer 

(or Seller's antiseptic tablets). 
Compressed tablets for making lime- 
water. 
Chlorate of potassium in five-grain 

tablets. 
Elixir of cascara sagrada (laxative), or 

compound liquorice powder. 
Menthol or red pepper (solid liniment). 
Powdered alum. 

A few bandages (in rolls of two widths). 
Compressed quinine pills, two grains 

each (fifty). 
Lady Webster pills. 
Dover's powder, compressed pills, five 

grains each. 
Tarrant's aperient, or Seidlitz powders. 
Glycerin. 
Listerine, 
Gallic acid. 
Absorbent cotton. 
A fever and a bath thermometer. 



Of course this is a very complete list, and many of the articles suggested will 
only be necessary for a family going to reside for a time at a distance from a physi- 
cian or drug-store. One should never travel without a supply of whiskey, mustard 
flour, flaxseed meal, and some pieces of old linen and flannel. 



3? 



434 MOTHER AND CHILD. 



CHAPTEE LIL 



SCARLET FEVER 



Scarlatina is the Latin name for scarlet fever in all its 
forms, those most grave and those most mild. There is 
another point of great importance, which is, that the mildest 
cases of scarlet fever have often the saddest ending, owing to 
the want of attention to those details of nursing which ex- 
clude the possibility of serious complications by exposure or 
neglect. Every doctor has heard the statement, when ques- 
tioning in regard to the antecedents of dropsy or possibly 
some destructive disease of the ear, " My child had only 
scarlatina; it was so mild that really we did not see the 
necessity of punishing the little one by confining it to its 
bed or room." 

Scarlatina is scarlet fever, and a mild attack of this most 
treacherous disease may become as serious as a very severe at- 
tack, — often more so, as the one will be cared for and the other 
neglected. It is, therefore, necessary thoroughly to understand 
the principal features of this disease. 

It is undoubtedly caused by the entrance into the system 
of a something which has all the characteristics of matter. 
This something, which, as we shall see, requires a certain time 
thoroughly to infect the blood in which it circulates before 
the symptoms of the disease show themselves, is called a 
germ. This germ has weight, proven by the fact that it occu- 
pies a certain space ; can be carried in clothing or merchan- 
dise, or by the air ; it does not evaporate or become gaseous ; 
it is transmissible, and at the same time is very subtle, can 

1 This chapter appeared, as an article by Dr. J. M. Keating, in Baby- 
hood for February, 1886, and is republished by permission of the publishers. 



SCARLET FEVER. 435 

insinuate itself in cracks and crevices, in the breath of indi- 
viduals, in their hair, in clothing, in letters. It is a living 
material, whose vitality may lie dormant for years, and then, 
like grain, grow under favorable conditions ; it can be de- 
stroyed by heat, probably by intense cold, or by chemical 
agents. But it is unlike the grain in one most important 
characteristic, which is this : a grain — say of wheat — may 
have remained dormant since the time of the Pharaohs, and, 
taken from a mummy-coffin, placed in heat and moisture, it 
will sprout, but will only produce one stalk. The germ of 
scarlatina may lie dormant, but when aroused into activity by 
suitable associations it will act as a leaven, — -as a ferment; 
this minutest microscopic object will perpetuate its species 
until it invades every organ and tissue of the body. On 
this account this disease is classed as zymotic (from zyma, fer- 
ment). 

Scarlet fever can be communicated by infected milk ; and, 
so far as we know, the milk has only to stand in the room 
where the disease exists, or has existed, to absorb the germs, 
which are so subtle, so light, and yet so tenacious, as to float 
in the air and adhere to particles of dust. 

We all know how much dust is constantly floating in the 
air ; let a beam of sunlight pass through an opening in the 
shutter, and we can readily see how the scales of the skin 
from the body, pieces of lint, etc., can carry these microbes 
which may be thrown off in the mucus from the nostrils and 
mouth or in the perspiration, and even in the urine. 

Not only are these secretions germ-carriers, — that is, con- 
tagious (and they have all been proven so by direct inocula- 
tion), — but the passages from the bowels as well as the urine 
are so. In that way sewer-air may be a means of their con- 
veyance ; drinking-water also, as well as the vapor from the 
soil on which these matters have been thrown. Bear in mind, 
then, that the scarlatina poison can be carried in this way 
hundreds of miles ; that it does not need the personal contact 
of individuals ; that it retains its vitality for months and even 



436 MOTHER AND CHILD. 

years unless it be subjected to certain influences that either 
entirely destroy it or deprive it of its malignancy ; these are 
intense heat, especially boiling or steam, plenty of fresh air, 
and certain chemical substances, as chlorine, sulphurous acid, 
and others. 

The poison of scarlatina is either inhaled by the individual 
or swallowed ; it is then taken up by the circulation, and, 
finding itself surrounded by material which develops it, vivi- 
fies it, is rapidly reproduced, and the symptoms of the dis- 
ease show themselves. This period between the reception 
of the poison and the appearance of the symptoms is called 
the period of incubation ; this is known to be from one to six 
days ; in some cases longer. 

Unless we definitely know that the child has been exposed 
to the disease, we cannot detect its presence till the rash ap- 
pears, and this takes place within twenty-four hours of the 
first symptoms. What are these ? Chill or convulsions, de- 
lirium, intense headache, sore throat, swelling of the glands 
of the neck behind the jaw (kernels), nausea or vomiting, 
associated with high fever, bounding pulse, and dry skin. The 
first three of these may be absent in mild cases ; the others 
are nearly always present to a greater or less degree. 

Under such circumstances what should be done ? The 
child should be put to bed by itself in a separate room ; it 
should have a hot foot-bath, the water — with or without mus- 
tard — about as warm as the hand can bear. It should be 
lightly covered with a sheet and light blanket ; it should be 
kept as quiet as possible, and given frequently warm milk in 
small quantities, with lime-water or so-called " cambric tea," 
and no solid food. Do not purge ; in fact, avoid all medicine 
• — with the exception possibly of a little sweet spirits of nitre, 
a teaspoonful to half a tumbler of sweetened water — until the 
doctor arrives. At the end of from six to eighteen hours the 
rash will appear. It will be noticed in patches, fading into 
the normal color of the skin, on the neck, shoulders, and chest, 
then on the abdomen, and finally on the trunk, arms, and 



SCARLET FEVER. 437 

legs. It resembles the redness produced by a mustard-plaster, 
and feels rough to the hand when fully developed. 

The disease is now fully determined ; the fever is high, the 
restlessness is usually increased, the throat symptoms are 
marked, and the secretions are diminished. The most urgent 
care is now to be taken in the nursing. All superfluous hang- 
ings, such as curtains or pictures, should be removed from the 
room. The child should be nursed by one who has all the 
details of the case under her charge, who should wear the 
simplest kind of clothing, that can be daily changed and 
washed or aired. She should have an adjoining room in which 
to keep her clothes and make her toilet. Everything that 
comes in contact with the child, such as towels, brushes, blank- 
ets, or sheets, should be kept rigidly separate, and thoroughly 
boiled and aired before being taken from the premises. 

The room should be kept thoroughly ventilated, either by 
keeping open a window in the adjoining room or by some 
arrangement attached to the window of the sick-room which 
will allow the ingress and egress of air without a draught ; 
the temperature should be kept at about 68° F., and regulated 
by a thermometer. If the room receives its heat from a fur- 
nace, the hot air should be made to pass over a pail of water 
containing either diluted Labarraque's solution or Piatt's 
chlorides, and a towel with one end dipped in such a solution 
should be tacked over the register. If there be a stove, or, 
better than all, an open grate, these solutions can be placed 
near by, so as to be readily evaporated and distributed 
throughout the room. 

The chamber should always contain some such solution in 
which to receive the excreta. A small quantity of urine 
should daily be collected in a clean vessel for the doctor's 
examination. It is usual to anoint the child with some greasy 
substance ; this allays the intense itching or pricking, which 
is most annoying, it softens the skin, which is inflamed and 
swollen, it depresses the fever to a certain extent, and it 
serves to collect the scales of the skin, which, if shed, act 

37* 



438 MOTHER AND CHILD. 

as carriers of contagion, and which are usually shed in flakes.- 
Washed lard, white vaseline, or carbolated or thyraolated vase- 
line are used. The child should have its mouth washed once 
or twice daily, as also other parts of its body, for purposes of 
cleanliness, and the water used should contain either very diluted 
Labarraque's solution, vinegar, listerine, or phenol-sodique, and 
possibly the doctor will order the frequent use of the hand-spray, 
using some good disinfectant for the throat in these cases. 

What are the dangers incident to scarlet fever ? Extensive 
disease of the throat with complications of diphtheria, dis- 
ease of the ear with permanent deafness, disease of the eyes ; 
more important than all, serious complications due to inflam- 
mation of the kidneys, made evident by dropsy and convulsions, 
often ending fatally. To avoid these, which may take place 
in the mildest cases, from exposure to draughts, imprudence, 
and want of cleanliness and attention, great care is necessary. 

The question of bathing or sponging a child ill with scarla- 
tina must be decided by the doctor. Sometimes it is necessary 
to depress the temperature, as a prolonged high temperature 
will kill ; but in all cases, however severe, cleanliness should 
be insisted upon, — the face and hands, the eyes, ears, mouth, 
and genitals, should be kept clean and free from secretions. 

The temperature usually remains high till the decline of 
the disease, — about the fourth or fifth day in ordinary cases. 
As soon as the fever has subsided and the eruption has faded, 
and the skin-shedding is well established, it is customary to 
sponge the body off thoroughly in tepid water and clean the 
head, using a fine sponge or soft linen, avoiding draughts, and 
keeping the body well covered, with the exception of the part 
being washed. We have found a preparation known as " Lit- 
tle's soluble phenyle" admirable in this connection, a few drops 
of it being added to the water. It is disinfectant and leaves the 
skin soft. As kidney-troubles usually show themselves during 
or following the scaling stage, greater precautions than ever 
are to be used at this time. The urine should be examined 
every day pr two. The diet should be mostly liquid. — that is, 






SCARLET FEVER. 439 

milk, or milk and lime-water, gruels, soups, and such like ; the 
child should be encouraged to drink freely of water, the bowels 
must move daily, if necessary by an enema, and under no cir- 
cumstances should the patient be permitted to leave the room 
unless great precautions have been previously taken. In this 
climate we have to be very particular, owing- to the sudden 
changes of temperature, and it is far better that the child 
should be kept in-doors a few days longer than the parents 
usually think necessary than to run the great risk of kidney 
diseases, or rheumatism with its serious effect upon the heart, 
which may follow such exposure. 

After the child has had several changes of underclothing, 
has been well washed a number of times, and at least two 
weeks have elapsed since the disease declined, it can be re- 
moved to another room, and the sick-room fumigated. This 
should be done by igniting some sulphur in a saucer in the 
room, all the windows and doors having been previously closed 
and the cracks stuffed. After twenty-four hours the room can 
be opened and full ventilation permitted. All the furniture 
should be wiped with a damp cloth, and the paint-work washed 
with water containing the chlorides or borax. The room should 
remain unoccupied for some time and be thoroughly aired. 

The school-room is undoubtedly the place most to be blamed 
for the distribution of scarlatina poison. To get rid of the 
other children they are sent there while the mother is nursing 
the sick one at home. Some children possess a remarkable 
immunity from this disease ; nevertheless they act as carriers 
of contagion. Then, again, servants or child-nurses often carry 
it in their heavy shawls from house to house, taking it directly 
from a sick-room to the nursery. 

Scarlatina, so far as we know at the present time, only 
comes from previous cases of the disease. Cleanliness not only 
lessens the danger of serious complications which are often fatal, 
and mitigates the severity of an attack, but it is the great germ- 
destroyer, and prevents the spread of this dread disease in house- 
holds. 



uo 



MOTHER AND CHILD. 



CHAPTBE LIU. 



MEASLES — MUMPS — VARICELLA, OR CHICKEN-POX. 

There are so many things in common between scarlet 
fever and measles that it will be unnecessary to repeat. 
Measles is a disease which comes from a special poison of its 
own, one which only produces measles ; this poisonous prin- 
ciple, or germ, is especially active in the breath, in the secre- 
tions from the eyes and nose, and the whole respiratory tract ; 
and as these secretions are very much more active — in fact, con- 
stitute a marked feature — in this disease, the child affected with 
it forms a focus of contagion for those who come in contact 
with the air which has passed over t*he surface of its mucous 
membrane. The anointed skin in scarlet fever, the absence of 
marked catarrh and of profuse secretion, the thorough isolation 
which is always insisted upon, probably account for the fact 
that measles seems by far the more contagious disease. There 
is another peculiarity which also accounts for this: the catarrh 
of measles, resembling an ordinary cold in the head, may be 
mistaken for such, and the child for the few days preceding 
the rash may associate with other children, and thus dissem- 
inate the elements of contagion. The period of incubation in 
this disease is from twelve days to two weeks, but of course 
during this time, unless there be a history of exposure, there 
is nothing special to attract our attention. The disease usually 
manifests itself by all the symptoms of a violent cold in the 
head: the eyes become suffused, very watery, and intolerant 
of light; the discharge from the nose is constant, the child's 
face puffy and red, apparently swollen ; there is a tendency to 
drowsiness. Of course there is fever, the child's skin is hot 
and dry, and the little sufferer rolls and tosses from side to 
side. These symptoms are not very marked at first, and the 
child is supposed to have caught cold ; but they increase in 



MEASLES. 441 

severity, and it is not until about the fourth day that the 
rash makes its appearance upon the face. Previous to this, 
however, if the throat be examined, the outline of a rash char- 
acteristic of measles can be determined upon it. All this time 
the child suffers with paroxysms of a dry, ringing, croupy 
cough ; the tongue is usually slightly coated, the appetite is 
lost, and the fever, with the catarrh of the mucous membrane, 
gives rise to intense thirst. The first appearance of the rash 
is upon the temple, the forehead, the neck, extending down 
the chest and arms, and finally covering the body. The word 
rash is a misnomer when applied to the eruption of measles, 
and refers more especially to that in scarlet fever. When 
noticed upon the forehead, the temple, or the neck, it seems at 
first as if it were beneath the skin, — a number of small clusters 
or points, resembling flea-bites, that form a crescent ; when the 
finger is passed over the surface, a slight elevation is noticed. 
These elevations increase until they rise distinctly above the 
surface and form a papule. As soon as the whole body be- 
comes covered with the eruption, the skin is decidedly rough 
and papular to the touch, and the crescentic outline of the 
papules in these patches over the entire surface of the body 
can be distinctly noted. There is no mistaking a case of 
measles at this stage, or confounding it with scarlet fever. 
The suffused eyes intolerant of light, with swollen eyelids, 
the puffy face covered with its speckled eruption, the exces- 
sive nasal discharge or evidences of swelling of the mucous 
membrane of the nose, the croupy cough, which is constant 
and annoying, are in themselves sufficiently plain to be the 
distinguishing features. The rash after three or four days 
gradually fades from the surface, leaving in many cases a 
slight staining of the skin in freckles or spots, disappearing 
first from the parts first affected. The fever gradually subsides, 
though the cough and evidences of bronchitis may remain for 
some time longer. The skin will not come off in flakes, as is 
usual in cases of scarlet fever, especially where no ointment 
has been used ; it is usually shed in small bran-like scales. 



442 MOTHER AND CHILD. 

The lungs bear the brunt of this disease in neglected or 
severe cases, and just as we guard the kidneys in scarlet fever, 
to prevent their congestion, so in this disease we protect the 
lungs from the very first, by carefully guarding against draughts, 
impressions of cold, internal congestion, by endeavoring to es- 
tablish the eruption over the whole surface of the body, by 
protecting the eyes from light and the skin from draughts. 
Measles is a disease which is very fatal among the poor, much 
more so than scarlet fever, — that is, in the earlier stages, — 
owing to the fact that acute diseases of the lungs, as congestion, 
pneumonia, kill very much more quickly than the diseases of the 
heart and kidneys that follow scarlet fever, which probably do 
not show themselves for weeks or months after the termination 
of the disease. Croup in all its forms, bronchitis, congestion 
of the lungs, pneumonia, may occur in the earlier stages of 
measles and be fatal, through exposures to draughts and 
through improper nursing ; nor, indeed, is a child entirely safe 
until all evidences of catarrh of the respiratory organs have 
disappeared. Taking a child into the cold air too soon may 
bring on a fatal pneumonia ; exposure to sewer-gas in the sleep- 
ing-room may produce a fatal diphtheritic croup ; exposure 
to the contagion of whooping-cough may engraft this disease, 
with serious results ; throwing off the bedclothes, thus chill- 
ing the body, may congest the lung or eventually affect 
the heart ; then, again, indigestion may produce an irritation 
of the bowel, and a serious diarrhoea follow. The mucous 
membrane of the stomach and bowel is affected in this disease 
simultaneously with the mucous membrane of the respiratory 
passages. Although vomiting is not so apt to occur as an initial 
symptom as in scarlet fever, still diarrhoea, especially in the 
heated term, is often a serious complication, probably indicating 
inflammation of the bowel, and should be carefully watched. 
Not alone do we have complications of so serious a nature as to 
threaten life, but in scrofulous children, or those who are simply 
run down, loss of sight or of hearing may be the result of careless 
nursing, or the child may die of "marasmus" (tuberculosis). 



MEASLES. 4-13 

The same general principles regarding the ventilation of the 
sick-room, cleanliness of the body, diet, ought to be observed 
in the nursing of measles as we have just laid down for that of 
scarlet fever, possibly slightly modified, owing to the difference 
in the two affections. Thus, in measles the tendency to pul- 
monary congestion will necessitate keeping the feet warm to 
promote circulation, and possibly the use of poultices to the 
chest, or of cotton or some non-conducting substance. A child 
with measles should be guarded as carefully against going out 
too soon as in scarlet fever. We will once more impress upon 
mothers the fact that if they have a dry, well- ventilated, sunny 
nursery, apart from the sleeping-room, it is a mistake to run 
any risk by taking a child out of doors when the weather is the 
least objectionable, — that is, on damp, raw, and foggy days, or 
when the winds are piercing. We insist upon this, not only in 
the case of children who are convalescing from disease, but 
even for those who are perfectly well. There would be fewer 
catarrhs and sore throats if this plan were more generally 
adopted. Great care should be taken, when a sick child has a 
movement from its bowels or bladder, that it is well covered 
and protected from draughts. 

We need not repeat all that has been said when speaking of 
scarlet fever, in regard to the diet and home treatment ; the 
mildest form of nourishment should be given, — milk, diluted 
with an alkali, given at frequent intervals ; also chicken-tea, egg 
albumen in water, beef essence or juice, with cracked ice, toast- 
water and wine-whey, or wine-whey and barley-water. JYo 
solid diet should ever be given in fevers. The child should be 
allowed to drink water freely, but in small quantities at a time. 
Glycerin and water, the proportion being a teaspoon ful in half 
a tumbler of water, will often relieve the dryness of the mouth 
and throat, at the same time allaying thirst. Weak lemonade 
sweetened with a little glycerin, not immediately after milk, 
is most refreshing in fevers. Sweet spirits of nitre, a teaspoon- 
ful to a tumbler of water, will quiet the nervous system, if the 
child drinks frequently of it during the night, and is likely to 



444 



MOTHER AND CHILD. 



promote sleep. A hot foot-bath is always efficacious, if the feet 
are kept warm afterwards. A teaspoon ful of spirits of Min- 
dererus, with a teaspoonful of sweet spirits of nitre, in a half- 
tumbler of water, forms a household fever-mixture which can 
be safely sipped by a child from time to time until the doctor 
arrives. Anointing the body, as in scarlet fever, with carbo- 
lated vaseline or cold cream, allays irritability even from the 
onset of the eruption. The room should be darkened, as the 
eyes are woak. 






MUMPS. 

This most painful affection is a common disorder of child- 
hood after the fifth or sixth year. Every one knows the ap- 
pearance of a child with the disease, and the frightful disfigu- 
ration which exists when one or both parotid glands become 
inflamed and swollen. The parotid gland is situated over the 
articulation of the jaw, in front of the ear, and either one or 
both are involved in this disease. Great pain is caused by 
moving the jaw, or, indeed, by any sapid substance in the 
mouth which makes the gland secrete saliva ; the pain radi- 
ates in all directions, owing to the nerves that are in con- 
nection with the parotid gland and the involvement of the 
chain of glands in the neck. The disease may occur without 
there being any other case in the neighborhood, but, as it is 
most contagious, it usually spreads from family to family, 
sparing none. 

It begins with slight fever, followed in twenty-four hours 
by stiffness in the jaw and earache, the stiffness extending 
down the neck ; then slight tumefaction over the gland of either 
one or both sides. The skin being tense, the swelling of the 
gland gives rise to great pain, which may be constant or par- 
oxysmal. The swelling extends to the glands below the jaw, 
and the face then becomes greatly disfigured. The disease 
usually reaches its height in four or five days and then declines ; 
but sometimes it runs a much slower course, not ending for 
two or three weeks. 



MUMPS. 445 

The treatment of this disease is, of course, that usually 
adopted in fevers of all kinds, — rest in bed, avoidance of solid 
food, water to drink, liquid diet, and, if the little patient is 
constipated, an enema of warm water and sweet or castor oil 
to unload the lower bowel. Should a doctor not *be obtainable, 
the mother should at once carefully examine the child's throat 
to note the presence or absence of membrane, or enlargement 
of the tonsils (quinsy), as diphtheria and quinsy are the two 
affections most likely to be confounded at first with this disease. 
But as soon as the tenderness and pain in the angle of the 
jaw develop, and the throat has been found free of patches 
and swelled tonsils, the true nature of the complaint is made 
evident. The blandest nourishment and fluids, as that is all 
the patient will tolerate, should be given, such as warm milk 
and Manitou, Yichy, or lime-water, peptonized milk or gruels 
made quite thin, wine-whey in small quantities, if the child is 
delicate; the white of egg in warm water, dissolved and sweet- 
ened slightly ; but all soups or beef-tea or any material that 
requires salt should not be given. As the jaw becomes swollen 
and painful it should be rubbed gently with warm sweet oil and 
laudanum, a tablespoonful of the former to a teaspoonful of 
the latter, or a sponge wrung out in hot water and covered 
with oiled silk, rubber cloth, or waxed paper, should be placed 
on the tender gland or made large enough to extend down the 
painful chain of glands of the neck. Avoid draughts, as catch- 
ing cold is a bad thing; avoid getting the nightclothes and 
bedclothes wet, but allow plenty of fresh air in the sick-room. 

Carefully sponge the child's body daily with tepid water, 
cologne, or listerine, and very carefully wash the mouth out 
several times a day with a soft linen rag and listerine or 
Dobell's solution. The viscid mucus, which is secreted in 
abundance by the inflamed gland, collects in the throat and 
causes choking or difficulty in swallowing, or gives a bad taste, 
while the pain caused by the slightest movement of the jaws 
prevents the child from getting rid of it. Ice to suck in small 
pieces, or crushed, is often most refreshing and acceptable; in- 

38 



446 MOTHER AND CHILD. 

deed, vanilla ice-cream is frequently the only nourishment a 
child will take, and is often a most valuable nutrient for the 
sick. 

Kemember the contagiousness of this disease and keep the 
other children away from the sick-room. It is astonishing 
how an attack of this sort will prostrate a child, so care must 
be taken, especially in winter, not to let one go out of the sick- 
room until all evidences of the disease have vanished, nor out 
of the house till there is strength enough to resist change in 
temperature. During convalescence a child should be liberally 
fed, at stated short intervals, with light puddings, — rice, sago, 
etc. ; nourishing soups made from " stock ;" gruels flavored with 
vanilla or raisins, so as to encourage the appetite ; milk, of 
course, and plenty of bread and butter, in addition to the 
regular diet of meat, eggs, vegetables, and fruit. 

VARICELLA, OR CHICKEN-POX. 

This disease, so common in children, is one of the mildest 
of all the contagious diseases, and yet is important, owing to 
the disfigurement which will follow unless carefully managed. 
It usually occurs in young children, and affects all in the 
family. 

There may be some fever, but there is nothing to call es- 
pecial attention to any particular disease other than a bad cold 
in the head ; but in twenty-four hours, probably as late as 
forty-eight, little distinct rose-spots with a darker point in 
the centre will appear, usually from fifteen to twenty-eight 
in number, scattered over the body. Sometimes there are 
more of them and sometimes they run together. On the 
second day a fresh crop appears, and by this time the first 
have turned into little bladders of clear water. In a day more 
these little vesicles have become milky in appearance, and 
by the fourth day from the milky appearance they have 
turned yellow and dried up, forming a scab, which on the eighth 
day falls off without leaving a permanent scar. But the erup- 
tion is apt to be very itchy, intolerably so at times, and the 



SECOND DENTITION. 447 

child will scratch it until it bleeds, causing the vesicles to 
become confluent in places, and ultimately resulting in disfig- 
uring scars. To avoid this the child's hands should have - soft 
mittens tied on them ; indeed, at times it would be well to tie 
the hands down for a day or two. The body, especially over 
the vesicles, or where they are most numerous, should be thor- 
oughly but carefully anointed with carbolated or thymolated 
vaseline (white). A warm bath towards the end of the attack 
is most soothing. As there is very little fever attending the 
disease, and children who catch it are usually young, but little 
change from the ordinary diet is required. 



CHAPTEE LIV. 

SECOND DENTITION. 

This work would be incomplete were we simply to devote 
our attention to that time which is limited to the cutting of 
the milk-teeth. There are various disorders of childhood that 
are dependent more or less upon the disturbance of the equi- 
librium that should be maintained between growth and devel- 
opment. This disturbance is usually brought about by the 
unnatural pressure which fashion or habit exerts upon the 
growing tissues of the child, by brain-forcing and muscle- 
cramping, by the want of that freedom and abandonment 
which gives food for the muscles' growth and carries away 
the ashes resulting from their destruction, and by the per- 
nicious system of over-education, that endeavors to place an 
•adult brain in a child's body. Indeed, this attempt at forcing 
is productive of the many disorders which attend the period 
of permanent dentition. 

It is not the cultivation of the mind that physicians object 
to, but the system by which it is often accomplished is radically 
wrong. 



448 MOTHER AND CHILD. 

After a child has passed its first dentition there is little to 
attract our attention, barring the complications that may arise 
from contagious diseases. About the sixth year it will cut 
the four first molars, about the twelfth year the four second 
molars, and after the eighteenth year the so-called wisdom- 
teeth. These teeth are all permanent ones, and the jaw has to 
change in shape and size to accommodate them as they grow ; 
they produce a certain amount of pressure upon the nerve-pulp 
at their base, and give rise to neuralgia and reflex disturbances, 
together with irritation of the mouth, the throat, consequent 
disorders of the tonsils, ear-troubles, and, possibly, disorders 
of the intestinal canal, interference with digestion, with blood- 
making, and perhaps, as a consequence, many of those pecu- 
liar hysterical phenomena that attend puberty both in boys 
and girls, but especially girls. In fact, a child's brain that is 
excited by over-study, over-stimulated, — in other words, con- 
gested, and by blood that is not of the purest, owing to defi- 
cient exercise and under-feeding, — falls a ready victim to the 
slightest pressure or irritation that results from the growth 
of these permanent teeth. The other sets of permanent teeth, 
that are cut from the sixth to the fourteenth year, simply take 
the place of milk-teeth, and, consequently, do not produce the 
same degree of irritation. It is, indeed, a difficult matter to 
decide in an individual case exactly how much disturbance is 
due to teething and how much to the general impairment of 
nutrition which results from the child's surroundings and 
mode of life. 

A strong, healthy child, brought up in the country, rarely 
has any difficulty at this time. 

The general impairment of nutrition, followed by debility, 
languor, all resulting from the loss of, or perverted, appe- 
tite, and defective secretions, are the most frequent disturb- 
ances that we meet with during second dentition. We have 
at this time, also, disturbance of the mucous membrane of 
the mouth, of the gums, due to the irritation of the milk- 
teeth, whose roots become absorbed; possibly, want of clean- 



SECOND DENTITION. 449 

liness may lead to incrustations or to a spongy condition of 
the gum, with pressure and ulceration. Enlargement of the 
tonsils, with various forms of inflammation, are also very apt 
to occur at this time, especially that variety which is attended 
by a grayish deposit, very readily mistaken for diphtheria, and 
to which the physician's attention should be immediately 
called. There is, too, a tendency to chronic enlargement of 
the tonsils, which will give rise to earache, sometimes difficulty 
in swallowing, snoring at night, with restlessness, and a ten- 
dency to acute inflammation or quinsy upon the least exposure 
to cold. 

Such children are prone to attacks of headache, toothache, 
or neuralgia of the face ; their tongues are apt to be coated ; 
they have frequent bilious attacks. At this time, also, what 
is known as scrofula is apt to develop; enlargement of the 
glands of the neck, weak eyes, nasal catarrh show them- 
selves. These conditions, although occurring at the same 
time as the second dentition, are by no means dependent 
upon it in all cases ; they are attendant upon excessive growth 
and faulty development, malnutrition, and inherited taints. 
During this time also occur frequently those deformities which 
are the result of improper deposit of lime in the bone, or of 
the reabsorption of bone from pressure due to all sorts of 
mechanical causes ; among these we find the diseases of the 
joints, curvatures of the spine, and also the imperfect forma- 
tion of the permanent teeth, which renders them brittle or 
soft, readily broken, or easily affected by the acid eructations 
that come from a disordered stomach, — a mere shell of a tooth, 
as it were, which soon becomes carious, and unfortunately 
cannot be replaced. 

We see, then, that the mother's attention should be called to 
her rapidly-growing child, in order to perfect its development 
in such a way that its tissue^ will be well formed and nour- 
ished, its functions established, by the time it reaches maturity. 
There are certain other disturbances which occur during 
second dentition that require our attention ; these are frequent 
dd 38* 



450 MOTHER AND CHILD. 

bilious attacks, or certain fevers apparently due to growth, 
that come on without any appreciable cause. A child will have 
a slightly-furred tongue, will complain of pain in its bones, of 
languor, loss of appetite, will be restless in its sleep, will suffer 
from headache, which is usually frontal. Suddenly it will de- 
velop a high fever, the face will be flushed, the eyes red, and in- 
deed, if vomiting occurs, and the child has not previously had 
the disease, we might almost expect the onset of scarlet fever. 
The child should have a hot mustard foot-bath, and should 
be given sweet spirits of nitre in its drinking-water ; if the 
tongue is coated, it should be given a dose of either Murray's or 
Phillips's fluid magnesia, or a dose of castor oil or spiced rhubarb, 
and the chances are that the next morning the child will awake 
bright and cheerful, without any bad results from its attack. 

Eheumatism is very common at this period of life ; indeed, 
many of the cases of so-called growing-pains are neither more 
nor less than masked rheumatism. If a child complains con- 
stantly of aching in its limbs, and seems loath to take exercise, 
the attention of the doctor should be called to its condition. 

Elsewhere we have written of the care of infants during the 
period which terminates at about the age of five years. Before 
this time there is not much to call our attention to any differ- 
ence between the sexes : the girls are usually more delicate, 
the boys hardier ; the girls, having more tender skins, are more 
liable to eruptions. Boys are more difficult to bring up, owing 
to the fierceness with which they are attacked by infantile 
complaints, and their greater exposure. Usually the difference 
in sex makes itself manifest in temperament as soon as the 
infant becomes sufficiently independent to amuse itself, and 
especially is this the case with the first-born, who has no one 
to copy, no playmate older than itself by whom it can be led. 
Even at this early age parents should as much as possible en- 
deavor to train a child to enjoy out-door amusements, and give 
it exercise, that it may grow hardy, graceful, and cheerful in 
disposition. This will have'to be encouraged in the girls; the 
boys take to it as ducks take to water. 



SECOXD DENTITION. 451 

It is during these tender years, while the bones are yet frail 
and soft, that those deformities which become the source of so 
much disease in later life develop themselves. People are apt 
to imagine that rickets and scrofula are confined chiefly to the 
lower classes, — to'the poor. This is a great mistake ; they enter 
every household where the conditions which favor their devel- 
opment are found. 

Let us dwell for a few moments upon a matter of so much 
importance in infant life. All the long bones of the body are 
composed of three parts : the two ends which come in con- 
tact with the same part of other bones and form the joints, 
and the shaft. In later years these ends become united to 
the shaft, and the whole becomes one solid bone. Bones are 
composed of two kinds of material : the gelatinous, which 
gives pliability and elasticity to them, and the mineral, which 
makes them firm and strong. Of the latter, the salts of lime 
form the most important part. 

In infant life the growing bone receives an immense amount 
of nourishment ; it grows rapidly. The centre is spongy and 
filled with blood-channels. The bones are by no means hard 
at this age, and should anything diminish the amount of lime 
they receive, or through malnutrition a low grade of inflamma- 
tion be engendered, the movements of the child, the straining 
of its muscles, the weight of its body, will cause the bones to 
curve, and unless attention is immediately given, this curving 
will be permanent. Especially is this the case where the bony 
shaft is attached to the cartilage to form a joint ; naturally, 
the rapid growth requires such joints to be loose and yielding 
and elastic, and the constant strain will so stretch them as to 
produce deformity. 

A child who, instead of running out in the fields or gayly 
skipping along the street, filling its lungs to the utmost and 
sending ample nourishment to every tissue of its body, sits by 
the hour by its mother's side nursing its doll, though a beautiful 
object, is also a melancholy one. as time will show that nature's 
laws are beino- interfered with. We know that there is a 



452 MOTHER AND CHILD. 

j>ressure of fifteen pounds to every square inch of surface on 
all bodies at the level of the sea. In breathing, a certain 
amount of force is required to overcome this. In a frail, deli- 
cate child, whose muscles are imperfectly developed, the lungs 
are scarcely ever inflated to their full extent, and the constant 
atmospheric pressure not being overcome, tends to flatten the 
chest-walls, so that when the bones are hardened the breast- 
bones assume the form known as pigeon-breast. One great 
cause of consumption is thus introduced. 

A child that is constantly made to breathe fully and deeply 
by means of out-door exercise, and who at the same time has 
its chest freed from all restraints of close-fitting garments or 
the injurious requirements of fashion, will in the future bless 
its parents for the great gift of health, which is an heirloom of 
priceless value. The girls as well as the boys should be straight- 
limbed and full-chested. 

The disease called rhaehitis, or rickets, is brought about not 
only in those children whose parents live in damp, ill-ventilated 
dwellings, devoid of all the comforts of life, exposed to the 
intense cold of winter and to the great heats and atmospheric 
impurities of summer; it is also noticed among the rich, who, 
possessing every comfort of life, may, either through ignorance 
or carelessness, fail to supply food which nature has intended 
to make bones firm and muscles strong, or they may neglect 
to see that their children are kept in a proper state of health 
to digest and assimilate such food. 

Fashionable mothers are only too desirous of transferring 
their duties to an experienced nurse, and consider that task 
complete which was intended by heaven as a sacred duty, when 
they have purchased the most fashionable baby-carriage and a 
full supply of condensed milk. Experiment has shown that 
the strongest animals can be made rickety by the character of 
the food on which they are fed, and experience shows that 
children who have a tendency to rickets, if fed upon nutritious 
food and given plenty of fresh air and exercise, can be made 
strong, and will outgrow the predisposition. It is on this ac- 



SECOND DENTITION. 453 

count that so much stress is laid upon the use of the various 
cereals in the. feeding of growing children, especially oatmeal 
and cracked wheat. Every child — after the completion of its 
first dentition — should be given three regular meals a day : the 
breakfast consisting of bread and butter, a plate of well-cooked 
oatmeal with cream and plenty of milk, a soft-boiled egg, a 
mutton-chop, or a piece of steak finely minced. Avoid hot 
cakes, very fresh bread, or rich dishes of any sort. For the 
dinner, which should invariably be taken at an early hour, it is 
an important matter, when possible, to give fresh vegetables, — 
well-cooked potatoes and rice properly boiled. — and encourage 
the children to eat bread and butter with their meals. They 
should also have either cooked fruit or ripe raw fruits in 
abundance. The final meal should be a varied one; meat 
should be avoided ; and it should consist of soft custards, milk- 
toast, or bread and butter made more inviting by a little good 
preserve. This outline will give an idea of the character of 
food that supplies brain, muscle, and nerve. It may be modi- 
fied according to the peculiarities of the child, the time of 
year, and the family circumstances. 

Do not let a mother suppose that because she has nursed her 
infant the usual time it cannot become rickety. Unless she 
lives upon food which will give to her milk in full proportion 
the quantities represented in the diet mentioned above, her 
child, though nursed and to all outward appearances subjected 
to only what is best for it, will in reality be no better off than 
a bottle-fed baby ; indeed, a child carefully brought up on the 
bottle by an experienced person will be healthy in all respects. 

We think that most mothers forget the important point that 
the nourishing quality of their milk depends on their own state 
of health. 

As far as the medical treatment of rickets is concerned, we 
need only mention here those drugs which are in reality other 
forms of food. Cod-liver oil is pre-eminently the most impor- 
tant. It may have been ordered by the physician in early infant 
life, but if, at the period of childhood of which we are now 



454 MOTHER AND CHILD. 

speaking, no physician is at hand, a mother should not hesitate 
to give it should the child complain of fatigue, grow thin, lose 
its appetite, or give other evidences of bad nutrition. 

Before concluding this chapter it may be well to make a few 
remarks regarding the dress of young children. Habits of 
regularity should be instilled at a very early age, and may be 
so well established that by the second year the diaper can be 
exchanged for drawers. Should summer make it convenient 
to do so at an earlier period, it may be well to make the 
change, as in some children the thick folding of the diaper is 
apt to make them bow-legged, especially if it is not very care- 
fully put on. This, of course, only refers to children who are 
walking. As regards the clothing of children in our damp 
seaboard climate, flannel should be insisted upon all the year 
round. 

Teething children should wear fine merino stockings all 
the year. Two important things to bear in mind are the 
simplicity and loose fitting of all their clothing ; the latter is 
most essential for growing children, as deformity, stooping 
shoulders, contracted chest, and weakened backs depend a 
great deal upon ill-fitting garments. Would that mothers 
were sufficiently impressed with this fact ! 

The next thing is the proper change of clothing to suit the 
seasons. Warm clothing is not necessarily cumbersome, and 
merino undershirts with high necks are certainly important, 
even in summer, though they be of the thinnest kind. Croup 
is, we think, not so prevalent as it used to be, and we can but 
attribute this to the much more common-sense way of clothing 
children than was fashionable some years ago ; bare-necked, 
bare-armed, and bare-legged babies in midwinter are no longer 
seen. — those frail flowers of our hot winter houses, so often 
the victims of fatal draughts. 

All children should wear thick-soled shoes, easy and well 
fitting, with room for growth at the toes; they should be 
without heels. . 

The importance of light calisthenics at this age cannot be 



SECOND DENTITION. 455 

over estimated. Not only do they give, under competent 
management, a graceful and easy carriage, which means sym- 
metrical development, but they supply muscular power, increase 
the force of the circulation, develop the chest and thereby the 
activity of the lungs, and give tone to the nervous system ; in 
other words, they improve the digestion and the appetite, and 
in that way secure a flow of good, nourishing blood. 

In conclusion, we will quote liberally from an excellent article 
that recently appeared in the Spectator : 

" The world has grown unconsciously much wiser as to the 
management of children. Nothing improves physique like 
good milk, — that, and not porridge, is the cause of the tall 
Highlanders, Irishmen, and Sikhs, — and the little children of 
our day are nourished on cream-and-water, or milk procured 
from the great dairies, which is as good as milk can be, and as 
different from the milk of thirty years ago as Brand is different 
from old beef-tea, The very cows are of different breed, not 
to mention the improvement in their food and lodging. Then 
a prejudice of an extraordinarily injurious character — we 
write these sentences on first-class medical evidence — has 
silently, no one knows why, entirely disappeared. Nothing 
nourishes like good sugar, possessing as it does just the requi- 
site heat-giving quality; but the mothers of 1830-50 dreaded 
sugar. They had an idea that it sickened babies, who always 
crave for it like horses for salt; that it spoilt the teeth of 
growing children; and that it swelled the tongues of children 
a little more advanced in years, — the last a fancy based on the 
effect of sucking toffy. They therefore withheld sugar, thus 
leaving the children half nourished, and permanently sensitive 
to a climate which for seven months in the year is always 
chilly. Nowadays, everybody among the cultivated knows 
that sugar is beneficial, and the children are left to their in- 
stincts, with the result that they make flesh, and are almost 
always warm. Then the matrons of 1830-50 had a fixed idea, 
incurable by the men, who never quite gave in to it, that 
children, if let alone, would invariably over-eat themselves, a 



456 MOTHER AND CHILD. 

theory true of about five per cent. The nurseries were dieted 
like prisons, with the result—all nurses exaggerating the pop- 
ular ideas — that the children who longed for food were never 
fed enough, and the children who disliked much food — a pecu- 
liarity of many good constitutions — were gorged to indigestion. 
And finally, children are kept warm enough. The horrible 
old idea of those two decades, that children should be ' hard- 
ened' by exposure, has died away; the nurseries, besides 
being properly ventilated, are kept warm, and the whole prin- 
ciple of children's clothing has been radically, and we hope 
finally, modified in the sense that the ' body,' as distinguished 
from the limbs, is thoroughly and warmly clad. The result 
is, that the child with a tendency to grow does grow, and that 
a greatly increased percentage of boys run towards five feet 
eleven inches, and of girls towards five feet eight inches, and 
five feet nine inches, than has ever been the case before. 
Moreover, as the boys and girls grow naturally, they keep 
their good looks, and, except for a year or two of life, it has 
become a positive rarity to see 'gawky' lads and lasses, as 
great a rarity as to see the latter with the shining red elbows 
which forty years ago were at once the most dreaded and the 
most frequent of the minor deformities. The improvement — 
always, mind, in a strictly limited class which hardly considers 
the cost of food — is manifest at every turn, and is reported not 
only by every artist, but every caricaturist in the country. 
The undersized lads and skinny girls have disappeared from 
pictures of the middle class, even when drawn with distinctly 
hostile intent. 

" Food has been helped by training. It has become a custom 
to let girls live in the open air, to suffer them to play games 
which thirty years since would have been pronounced l hoi- 
denish,' — then a most opprobrious adjective, — and even to train 
them through gymnastics with scientific attention and regu- 
larity. They may take as much exercise as they like, and 
owing to the partly accidental introduction of vigorous games 
in which both sexes can share, they like to take a good deal. 



SECOND DENTITION • 457 

' Ladies' cricket' and ' ladies' golf are imitative tricks, with 
nothing to recommend them but the open air ; but lawn tennis 
is sharp, healthy work, a great deal better than the hay- 
making of the last century, which overtaxed the spine ; and so 
are riding, as now practised, and the walk of eight or ten 
miles, even if it ends in a rather fatiguing trudge. Exercise 
of that kind, while it makes the boys lissome, sets the girls up. 
a change which is no doubt one cause of their apparent increase 
in height. They stand on their feet and stand up as their 
grandmothers, with all their drilling on backboards and in- 
junctions to sit straight up against chair-backs, which were 
tortures, never did. The girls stand like soldiers, without 
their stiffness ; and because they can do it, and know they can, 
they fall instinctively into a style of dress which displays their 
ability, which recognizes, for example, the place of the waist 
in the human figure. G-irls do not 'lollop' now, have, indeed, 
almost forgotten a word which forty years ago was incessantly 
in their seniors' mouths, and was the origin in thousands of 
cases of positive physical harm. A well-bred girl nowadays 
does not sit as if she were listening to a rebuke, and stiffening 
herself to disregard it ; but she does not ' lollop,' any more 
than she ties her waist-belt about five inches too hi«;h." 



39 



INDEX. 



Abortion, 23. 
Absorbent cotton, 249. 
disinfectants, 379. 
Acacia water, 129. 

Acidity of saliva, cause of caries, 332. 
Adams, Dr. S. S., on diet after early den- 
tition, 320, et seq. 
Adhesive plaster, 250. 
After-birtb, dangerous when not ex- 
pelled, 62. 
destruction of, 62. 
Air, bad, a cause of consumption, 1S9. 
fresh, allowance of, per head, 223. 
how to get rid of carbonic acid in, 

287. 
impurities of, divided into three 

classes, 222. 
need for moisture in, 227. 
of sick-room moistened with steam, 

367, 368. 
open, for the infant, 52. 
Air- and water-poisoning, effects of, 228- 
230. 
passages, diseases of the, -ill, et seq. 
Alcohol, dilute. 252. 
Alkali in croup, vapor of an, 420. 
Amenorrhcea, 172. 
American model of seat and desk, 204, 

205. 
Amherst College, light gymnastics at, 

215. 
Antidotes, 26S-274. 
acid, 274. 
alkaline. 274. 
Antisepsis, 60. 
Antiseptic gauze, 249. 
wash for eyes, 390. 
Antiseptics for use in childbirth, 49, 50. 

in puerperal fever, 61-63. 
Aperient, Tarrant's, 171. 



Arnold steam sterilizer, 112, 420. 
Arnott, Neil, 190. 

Arrow-root not to be used in child's diet- 
ary, 321. 
Artery, w r ounded, 248. 
Artificial light, how to get rid of its car- 
bonic acid, 287. 

spoils air for breathing, 287. 
Assafoetida in teething, 314, 315. 
Astigmatism. 213. 

glasses for remedy of, 213, 214. 
Atmosphere, pure, 222, 223. 
Atomizer for sore throat, 413. 

in whooping-cough, 428. 
Aural disease due to nasal obstruction, 
410. 



B, 



Baby -band, crocheted, 55. 

" Baby foods," indiscriminate use of, 157. 

Back, hollow, 216. 

Backache, 187. 

Bacon's, Miss A. M., book on " Japanese 

Girls and Women," 294. 
Bandages, 249. 
Barley, directions for preparing, 144. 

in bottle-feeding, 143, 444. 
Barrett's, Dr. Howard, book on cuts and 

other wounds, 242. 
Basket, child's, 53. 

outfit for, 54. 
Bath for debilitated child in hot weather, 
303. 

cold-water, 302. 

of the infant, 80, 81, 298, et seq. 

salt, when to be used, 300, 301. 

temperature of, for infant, 298, 299. 
Bathing, 298. 
Bed after labor, 59. 

for an operation, preparing of, 372. 
• 459 



460 



INDEX. 



Bed prepared for childbirth, 58. 
Beef, peptonized, 322. 

Valentine's extract of, 161. 
Beef-juice, directions for making, 161. 
Beef-soup as supplemental food in nurs- 
ing, 158. 
Beef-tea, 158. 

as after- weaning diet, 321, 322. 
Bichloride of mercury, 378. 
Binder, abdominal, 46, 47. 

child's, 83, 84. 
Birth, miscalculations regarding, 23. 

premature, 22, 23. 
Bites of cats, 267. 

of dogs, 267. 

of rats, 267. 

of venomous serpents, 266. 
Bladder, irritability of, during preg- 
nancy, 36. 
Blair Sons, makers of sterilizer, 117. 
Bland liquids, 274. 
Bleeding from the eye, 397, 398. 

stopping of, 246, 247. 
Blind people, low vitality among, 208, 209. 
Blisters for children, 365. 
Blood-poisoning, 60. 
Boarding-schools, 182. 
Boiling milk, 107, 111. 
Bones, development of, 451, 452. 

growing, in second dentition. 451, 452. 
Bonnets for children in cold weather, 408. 
Borax, dry powdered, 251. 
Borden's condensed milk, 132. 
Boric acid, 251. 
Boro-glyceride, ointment of, for the eyes, 

393. 
Bottle-feeding, 104, 124. 
Bottle for a delicate babe, 128. 

how to prepare, 119. 

prepared, 138. 
Bottle-food for child of four months, 156. 
Bowditch, Prof. H. I., 190. 
Bowel, catarrh of, 352. 
Bowels, care of child after movement of, 
336. 

daily movements of, at six months, 
337. 

hemorrhage from, 268. 

mother's knowledge of, 336. 

movements of, up to three or four 
months, 336. 

normal condition of, in children, 336. 

regulation of, 171. 



Brain, care of, 94. 

concussion of, 260. 

irritability of, 184. 
Bran a laxative, 143. 

Bread jelly for children just after wean- 
ing, 321. 

how made, 321. 
Breast, putting the child to the, 81, 87, 88. 
Breast- and bottle-feeding, association of, 

157. 
Breast-binder, 49. 

Breasts, care of, during pregnancy, 37, 38. 
Breathing, artificial light spoils air for, 

287. 
British soldier's daily gymnastics, 218. 
Broad-brimmed hats for children, 398. 
Bromide of potassium in teething, 313, 

314. 
Bruises, 241. 

Buchner on desk and seat, 202. 
Burns, 261. 

of the eye, 397. 

with acids, 261. 

with caustic alkalies, 262. 

with hot pitch, 262. 
Byers, Dr., on disinfection, 373, et seq. 



Caille, Dr., 112. 
Calisthenics, 165, 214, 454, 455. 

light, in second dentition, 454, 455, 
Candy, pickles, etc., morbid appetite for, 

12. 
Cane-sugar, 132. 
Canfield's condensed milk, 132. 
Cap, baby's, 52. 

under flannel, 408. 
Carbolic-acid ointment, 252. 
Carbonic-acid gas, 222. 
Carbonic acid in air, how to get rid of, 

287. 
Carlsbad salt, 178. 
Carmichael, 190. 

Carpets, movable, for the nursery, 283. 
Casein, 125. 

Catarrh, age at which children show 
symptoms of, 381,383. 

cause of diarrhoea, 353. 

Dr. Alexander MacCoy on treatment 
of, 380, et seq. 

earliest symptoms of, 381-383. 

evidences of, 352, 353. 

from wet feet, 427. 



INDEX. 



461 



Catarrh, how brought about, 353. 

in children overclothed, 427. 

nasal, acute and chronic, 380, et seq. 

of the stomach and bowel, 352. 

post-nasal, 382. 

precautions for preventing, 383, 384. 

produces diarrhoea, 353. 

treatment for, 353, et seq. 
Cats, bites of, 267. 
Cereals, 141. 
Chadwick, Edwin, 180. 
Chafing of infant skin, prevention of, 55. 
Chemical disinfectants, 376, et seq. 
Chest, smallness of, 217. 
Chicken-broth for children after wean- 
ing, 322. 
Cnicken-pox, 446, 447. 
Child, appliances for the new-born, 50- 

53. 
Childbirth, antiseptics for use in, 49, 50. 
Child's clothing warm and loose, 85. 
Chimneys, construction of, for ventila- 
tion, 287. 
Chloride of lime, 377. 
Chlorine, 377. 

Cholera infantum, aggravation of simple 
diarrhoea mistaken for, 353. 

true, not very common, 353. 
Chorea brought on by school-work, 184. 
Clarke's, Dr., " Sex in Education," 188. 

replies to, 188. 
Clean cut, treatment of a, 243. 
Cleanliness in pregnancy, 28. 
Cleft palate, 76. 

Climate, temperate and equable, for preg- 
nancy, 41. 
Clothing, child's, warm and loose, 85. 

for period of second dentition, 454. 

house, for the child, 52. 

of the sick child, 371. 

woman's, 17, 18. 
Cod-liver oil, 453. 
Cold cream, 252. 
Cold, effects of, 263. 

how to treat, for a child over six 
months of age, 380. 

in the head, 380. 

should never be neglected, 380. 
Colic in nursing babies, 100-102. 
Collodion, 244. 

Command, parent's, to be observed, 281. 
Comrades, children sensitive to influence 
of, 185. 



Conception, conditions influencing, 19, 
20. 
periods of liability to, 20. 
Concussion of the brain, 260. 
Condensed milk, Borden's, 132. 
Canfield's, 132. 

how to be used in weaning, 157. 
Confinement, diet after, 64-69. 
first few days after, 63. 
getting up after, 71. 
Congestion of the eyes, 211. 
Consciousness, loss of, 259. 
Constipation, agony of menstruation due 
to, 175. 
cause of, in infant at the breast, 337, 

338. 
diarrhoea of, 339. 
Dr. C. A. Earle on, 344, 345. 
Dr. A. Jacobi on, 345-347. 
Dr. Walker's recommendation for, 

343. 
does not always mean faulty action 

of the liver, 338. 
due to derangement of digestion, 342. 
to various causes, 339. 
to want of propelling power in 
the bowel, 340, 341. 
enema in cases of, 340. 
in infancy, 337, et seq. 
tendency in the child to, 337. 
water as a laxative in, 340. 
Consumption, 189. 

bad air causing. 189. 

caused by school-influences. 189. 

damp soil a predisposing agent to, 

192. 
hereditary tendencies to, 191. 
incipient, disqualifies for bearing 

children, 27, 28. 
report on causes or antecedents of, 
192. 
Contagion at funerals, 240. 
Contagious diseases in schools, 231. 

preventing the spread of, 232. 
Contusions, 264, 265. 
Convulsions, 259. 

Dr. A. Jacobi on treatment of, 314. 
Cord, cutting the, 83. 
Corporal punishment, 221. 
Corsets for the ignorant and stupid, 17. 
should not be worn by young women, 
170. 
Cotton, absorbent, 249. 



39* 



462 



INDEX. 



Country excursions for poor children, 355. 
Cow's milk, advantages of, 109. 

effect of, 88, 107, 128. 

fresh, from the bottle, 351. 

stale, 351. 
Cradle, 53. 
Cream, cold, 252. 

Creeping in one position injurious, 309. 
Croup, 414, et seq. 

boys more apt than girls to have, 414. 

child's diet in case of, 422. 

cough during the day, 418-422. 

croupy coughs all serious, 423. 

emetic in suffocation from, 421. 

fever mixture for croupy cough, 421. 

how averted, 414. 

lime in treatment of, 420. 

membranous and diphtheritic, 416, 
et seq. 
of two varieties, 417. 

obstruction of larynx in, 417, 418. 

spasmodic, 415, 416. 

treatment of mucous membrane in, 
419, 420. 

vapor of alkali in, 420. 
Curd, predigesting the, 146. 
Curvature, spinal, in schools, prevention 

of, 195. 
Curved spines, 169. 
Cuts and other wounds, 242. 

clean, treatment of, 243. 

Dr. Howard Barrett's book on, 242. 
Cutting teeth, lateness in, 309. 



Damp soil predisposing to consumption, 

192. 
Darby, Dr. E. T., on care of the teeth, 

333-335. 
Davis, Dr. E. P., 116, 140. 
Debility in early girlhood, 168. 
Decayed meat, 274. 
Decorum, misguided sense of, 196. 
Deformities, spinal, 192. 
Delayed menstruation, Dr. Mathews 

Duncan on, 173, 174. 
Delicate babe, bottle for, 128. 
Dentifrices, their composition and use, 

334. 
Dentition, early, diet after, 317, et seq. 
second, 447, et seq. 

clothing for the period of, 454. 
disorders of, 447-450. 



Dentition, second, growing bones during. 
451, 452. 
light calisthenics at the age of, 

454, 455. 
rickets a disease of, 452, 453. 
Desks and seats, Buchner on, 202. 

in school, 197. 
Detention as a means of punishment, 

221. 
Diarrhoea, 348, et seq. 

due to over-feeding, 349, 350. 

enema for, 365. 

from catarrh, 353. 

immediate treatment of sudden cases 

of, 356. 
indigestion the common cause of, 348. 
mother's duty in case of, 356. 
of constipation, 339. 
result of improper feeding, 324, 350, 

351. 
treatment of. 353, et seq. 
Diet after confinement, 64-69. 

after early dentition, 317, et seq. 

Dr. S. S. Adams on, 320, et seq. 

from the third to the fifth year, 327, 

et seq. 
greater variety in, 319, 320; 
Digestion, 139. 

constipation from deranged, 342. 
of fat, 135. 
Dilute alcohol, 252. 
Dilution of milk, 135, 140. 
Diphtheria, 231, 239. 

chief sufferers from, 279. 
nursing in, 368,423. 
Directions on medicine-bottle to be read 

by mother or nurse, 372. 
Discharges, disinfectants for, 368, 369. 
Disinfectants, absorbent, 379. 

bichloride of mercury (corrosive sub- 
limate), 378. 
carbolic acid, 378. 
chemical, 376, et seq. 
chlorine, 377. 

for linen and discharges, 368, 369. 
fumes of sulphur (sulphur dioxide), 

376. 
in the nursery, 289. 
Disinfection, Dr. Byers on, 373, et seq. 
heat as an agent of, 374. 
Labarraque's solution for personal, 

373. 
steam rapid and powerful for, 375. , 



INDEX. 



463 



Disordered menses a symptom of over- 
pressure, 187. 
Disorders of second dentition, 447-150. 
Dobell's solution in whooping-cough, 428. 
Dogs, bites of, 267. 
Douche bath, 371. 
Drainage and sewerage, -228. 
Draughts of cold air, protection of the 

child from, 79. 
Dress, infant's, hygienic essentials of, 290, 
291 , et seq. 
ordinary objectionable, 291. 
of older children, 293, 294. 
of the girl, 11. 
Dressing-materials for wounds, 249, 250. 
Drinking-water, pure, 279. 
Drowning, 252. 
Dulles, Dr. Charles W., on treatment of 

wounds, 249-251. 
Duncan, Dr. Mathews, on delayed men- 
struation, 173, 174. 
Dysentery and diarrhoea, 230. 
Dysmenorrhcea, 172, 178. 
Dyspepsia, national trait of Americans, 
183. 
school in some cases responsible for, 

183. 
symptom of overwork at school, 183. 



Ear, diseases of the, 399, et seq. 

aural disease due to nasal obstruc- 
tion, 410. 

child with running ear may go out 
in the cold, 408. 

cleansing discharging. 400, 401. 

cotton not to be worn in the, 408. 

discharges from the, 399, et seq. 

foreign bodies in the. 258, 259, 407. 

how the ears should be kept clean, 
406, et seq. 

inflating the middle ear, 402. 

John C. Saunders, M.D., on anatomy 
of the, 404. 

running ears in children under two 
years of age, 405, 406. 

soap and water poisonous to the, 
400. 

syringing the, 401. 

wax in the, 406, 407. 
Earaehe in a babe, 399, 400. 
Earle, Dr. C. A., on constipation. 344, 345. 



Eclampsia, or convulsions, occurring in 

pregnancy, 27. 
Education and school-hygiene, 179-241. 

meaning and scope of, 179. 
Egg as substitute for infant food, 158. 
Elixir cascara sagrada, 171. 
Enema in cases of constipation, 340. 
English school-boy- described by A. Mac- 

laren, 217. 
Epilepsy from overwork in school, 186. 
Epileptic fits, 259. 

Eruptive diseases, treatment of, 369. 
Evacuations, duty of nurse respecting, 

366. 
Evaporated milk, 133, 134. 
Excessive use of eyes, 210. 
Exhaustion from disease or inanition, 
treatment of, 154. 
heat-, 263. 
Eyes, diseases of the, 208, 388, et seq. 

antiseptic wash for treatment of, 390. 
baby's, how to be treated immediately 

after birth, 388, et seq. 
bleeding from the, 397, 398. 
congestion of the, 211. 
dilatation of the pupils of the, 389. 
excessive use wearies the, 210. 
foreign bodies in the, 257. 
geometrical deformity of the, 212. 
hereditary influence in defects of the, 

212. 
ointment of boro-glyceride for the, 

393. 
physiological laws of distance for 

the, 211. 
proper care of, 394. 
swelling and inflammation of, 389, 

390. 
treatment of, night and day, 391. 



F. 

Fainting, 259. 

Fairchild, Mr., on peptonizing food, 14G- 

150. 
Fairchild's liquor pancreaticus, 154. 
Family medicine-chest, 433. 
Farinaceous foods, 141. 
Fat, digestion of, 135. 
Feeding-bottle a great offender, 367. 
Fever, 429, et seq. 

is a symptom, 429. 

puerperal, antiseptics for, 61-63. 



464 



INDEX. 



Fever, what the mother should do for 

the child with, 431,432. 
Filter, the Pasteur, 279. 
First year, growth of child during, 308. 
Fish-hooks, how to remove, 266. 
Fits, epileptic, 259. 
Flooding after childbirth, 59. 
Folding-bath, 80. 
Folsom, Dr. C. F., 184. 
Food as constituted by nature, 319. 

choice of, for a child a matter of 
experiment, 152. 

test of, the thriving of the child, 152. 
Foods, table of, 153. 
Foreign bodies in the ear, 258, 259, 407. 

in the eye, nose, and ear, 257. 
Frankfort-on-the-Main, school gymnas- 
tics of, 219. 
Freezing, 263. 
Fresh air, 275. 
Friedrichshall, 171, 178. 
Funerals a source of contagion, 240. 
Furnace, hot-air, 284. 
Furniture of the nursery, 283. 



Gastric .price, 140. 

Gauze, antiseptic, 249. 

Geometrical deformity of the eye, 212. 

Germany, excessive study in the schools 

of, 184. 
Girlhood, debility in early, 168. 
Girl's dress, 11. 

life, hygiene of the, 9. 
Glasses for long-sight, 213. 

for near-sighted child, 213. 

for remedy of astigmatism, 213, 214. 

headache cured by, 184. 
Gluten suppositories, 172. 
Glycerin suppositories, 172. 
Grape-sugar from cereals an aid in nutri- 
tion, 151. 
Growing girls, nourishment of, 11. 

stimulants and narcotics should not 
be given to, 12. 

ten hours of sleep for, 12. 
Growth of child during first year, 308. 
Gum-arabic water as nourishment, 154 
Gums in teething, 304, et seq. 

when to be lanced, 313. 
Gymnasium, apparatus of the, 216. 
Gymnastics, light, Amherst College, 215. 



H. 

Hair, care of, in infancy, 289. 

pillows, 396. 
Harris, W. T., 182. 
Harvard University, 216. 
Hats, broad-brimmed, for children, 398. 
Haward on backache, 187. 
Head, cold in, 380. 
Headache cured by suitable glasses, 184. 

various causes of, 184. 
Heat an agent of disinfection, 374. 
Heat-exhaustion, 263. 
Heating, methods of, 277. 
Hemorrhages, special, 267. 
Hitchcock, Professor Edward, M.D., 215. 
Hollow back, 216. 
Holmes, Oliver Wendell, 61. 
Hot-air furnace, 284. 
House-clothing for child, 52. 
House-service, benefits of, to lives and 
health of women, 19. 

need of properly-trained women for, 
18, 19. 
" Humanized milk," directions for, 130. 

for infants with feeble digestion or 
disordered stomach and bowels, 
130. 

for the daily food of a healthy nurs- 
ing infant, 130. 
Hunyadi water, 178. 
Hygiene of the girl's life, 9. 
Hypermetropia, or long-sight, among 
school-children, 213. 

choice of glasses for, 218. 
Hysterics, 259. 



Impurities of air, 222. 
Inanition, exhaustion from, 154. 
Incipient consumption unfits for bearing 

children, 27, 28. 
Incised wound, treatment of an, 243. 
Incubation of disease, 425. 

of measles, 440. 
Indigestion, causes of, 145. 

child should be watched for symp- 
toms of, 145. 

great cause of diarrhoea, 348. 
Infant's dress, 290, 291, et seq. 

objectionable, 291. 

softness of material for, 290. 
Infection and spread of measles, 369. 



INDEX. 



465 



Inflammation of the eyes, 389, 390. 
Inflating the middle ear, 402. 
Injections, 357. 
Insanity in pregnancy, 28. 
Iodoform, 251. 

J- 

Jacobi, Dr. A., 91, 97, 104, 125, 132, 157,161, 

314, 315, 346, 347. 
Jacokes's illustrations of ventilation, 226. 
Jeffries's, Dr., article on best type for 

clearness, quoting from Javal, 209. 
Jenner, Sir William, 306. 
Jute, 249. 

K. 

Keeping the nursery, 362. 

Kindergarten, 179, 181. 

Kissing, diseases carried by, 412, 418. 

Knapp, Dr. H., 395. 

Knitted garments, 290. 



Labarraque's solution for personal disin- 
fection, 373. 
Labor. 56-60. 

bed after, 59. 

prepared for, 58. 

care of patient during, 57-60. 

rest after, 63. 

three stages of, 56-59. 
Lacerated wounds, 265. 
Lactation, 74. 
Lactopeptine, 154. 
Lady Webster pills, 172. 
Landolt on leading causes of myopia, 

208. 
Larynx, obstruction of, 417, 418. 
Lateral curvature, 192. 
Laudanum, 252. 

Laws of distance for the eye, 211. 
Laxatives, 171, 172. 

bran, 143. 

molasses, 344. 

syrup, 344. 

water, 145, 340. 
Lead-water, 252. 
Leconte, Dr. John L., 230. 
Leeches for children, 365. 
Leeds, Professor Albert R., 116, 156. 
Legs developed by sports, 217. 
Lesson for children at different ages, 
length of, 181. 
ee 



Letters, correct slant of. in writing, 207. 
Liebig foods, 135, 151, 152, 153. 
Liebreich's desk and seat, 203. 
Light, 209. 

artificial, spoils air for breathing, 287. 

poor, cause of near-sight, 211. 
Lighting, defective, 209. 
Lightning-stroke, 262. 
Lime, chloride of, 377. 

in treatment of croup, 420. 
Lime-water, preparation of, 122, 123. 
Lincoln, Dr. D. P., 180, 224. 
Linen, disinfectants for, 368, 369. 

for outer garments, 290. 
Lint, 249. 

Liquid diet for weakly children, 325, 
et seq. 

how to prepare, 324. 

recipes for, 324, 325. 

when to confine children to, 324. 
Liquids, bland, 274. 
Liquor pancreaticus, Fairchild's, 154. 
Little's soluble phenyle in scarlet fever, 

438. 
Long-sight among school-children, 213. 
Loring on causes of near-sight, 208. 
Lungs, brunt of measles borne by, 442. 

hemorrhage from the, 267. 

M. 

MacCoy, Dr. Alexander W., on treatment 

of nasal catarrh, 380, et seq. 
Maclaren, Archibald, 217. 
Maid, child's, ignorance and stupidity 

of the average, 53. 
Malt as an aid to digestion of starchy 

food, 152. 
Mammary glands, improvement of sub- 
stance of, 92. 
Manitou water, 135. 
Map-drawing, best plan for, 209. 
Massachusetts Board of Health Report, 

1882-1883, 209. 
Massage during mother's recovery, 71. 
for girls at age of menstruation, 165. 
in constipation, 345. 
popularity of, 17. 
Measles, 440-444. 

danger of exposure after, 442. 
incubation of, 440. 
infection and spread of, 369. 
lungs bear the brunt of, 442. 



466 



INDEX. 



Measles, nursing of, 443, 444. 
symptoms of, 440. 
very fatal among the poor, 442. 
Meat, decayed, 274. 
Meat-juice press, 161. 
Medicine-chest, family, 433. 
Medicines to be kept out of child's reach, 

372. 
Meigs, Dr. A. V., on preparation of bottle, 

121, 142. 
Mellin's food, 151, 152. 
Mendelson, Dr. Walter, article on Arnold 

sterilizer by, 112-116. 
Menorrhagia, 172. 
Menses disordered from over-pressure, 

187. 
Menstrual irregularity, womb-troubles 

from^ 169. 
Menstruation, age at which it appears, 165. 
agony of, from constipation, 175. 
attempts harmful and fatal to bring 

on, 172. 
delayed, Dr. Mathews Duncan on, 

173, 174. 
deviations from normal condition of, 

167. 
disordered varieties of, 172. 
duration of the period of, 167. 
duty of mother in, 166. 
. establishment of, 14. 
false and true treatment of, 14-16. 
remedies for, curse of house- 
hold, 175. 
general treatment during disturb- 
ances of, 164, 165. 
girl's understanding of, 166, 167. 
home-influences during beginning 

of, 16. 
hysterical phenomena sometimes at- 
tending, 167. 
natural impulse of girls at beginning 

of, 162. 
normal, should be painless, 168. 
pain during, 174-179. 
painful, bow to relieve, 176. 
pernicious influences at period of, 

162, 163. 
phenomena of, 165. 
preparation for, 14. 
return of the period of, 167. 
severest form of, 177. 
signs of the advance of a period of, 
167. 



Menstruation, treatment in extreme cases 

of, 177, 178. 
Mental education of the girl, 12, 13. 
Mercury, bichloride of, 378. 
Middle ear, inflating the, 402. 
Military drill, 217, 218. 
Milk, adulteration of, 108. 

advantages of boiling, 111. 

of sterilizing by steam, 111, 112. 

bad, causes of, 106, 107. 

oare in selecting and preserving, 107. 

condensed, 88, 131, 132. 

dilution of, 108, 135, 140. 

diseases carried by means of, 107. 

evaporated, 133, 134. 

excessive flow of, 75. 

"humanized," directions for, 130. 

laws against impure, 108. 

mixed, 107. 

mother's, 98, 104. 

obtained from a single cow, 107. 

peptonized, 151. 

scanty supply of, 76. 

sugar of, 132. 

suspected of taint should be boiled, 
107.- 

tablets for use in, 127. 

tainted, fatality of, 104. 

temperature of, for the child, 126. 
Milking, directions for, 108, 109. 
Mindererus, spirits of, in fever, 431. 
Miscarriage, 25, 26. 

causes of, 25. 

dangers attending abortion and, 25. 

disorders following, 26. 

medical aid and treatment for, 25, 26. 
Mixed milk, 107. 
Modern surgery, marvels of, 117. 
Moisture in air, 227. 
Molars, sixth-year, 332. 

twelfth-year, pressure of, 162. 
Mother, appliances after childbirth for 

the, 45-50. 
Mother's milk, 98, 104. 

substitute for, 119. 
tuberculosis conveyed through, 
28. 

recovery in childbirth, 70. 
Mouth at various stages of teething, 305. 
Mouth-wash, formula for an excellent, 

335. 
Mucus, detaching, in whooping-cough, 
428. 



INDEX. 



467 



Mumps, 444-446. 

nature of, 444. 

treatment of, 445. 446. 
Muscular development in growing girls, 
t 163. 

Mustard poultices, 843. 
Mutton-broth for children after weaning, 

322. 
Myopia, Landolt on, 208. 

leading causes of, 208. 

N. 

Narcotics and stimulants not to be given, 

12. 
Nasal catarrh, Dr. A. W. MacCoy on treat- 
ment of, 380, et seq. 

obstruction a cause of ear-disease, 410. 

passages, 102. 
Navel, 85. 
Near-sight caused by poor light, 211. 

Loring on causes of, 208. 
Near-sighted child, glasses for the, 213. 
Near-sightedness, 208. 
Neglect of eyesight, Soldan on, 209. 
Nervines, etc., no part in children's diet. 

159. 
Nervous system, care of, 33, et seq. 

derangement of, 184. 
Neurasthenia, or break-down, 186. 

common in young women, 186. 
New-born child, appliances for, 50-53. 

care of the, 79. 
Nipple for nursing, care of the, 38, 81.99. 
Nipple-shield, 55, 81. 
Nose, bleeding from, 267. 

best methods for stopping, 386-388. 

blowing the, 384. 

foreign bodies in the, 258. 

germs of whooping-cough in secre- 
tions from the, 426. 
Nostrums to be avoided, 429. 
Nourishment of growing girl, 11. 
Nuisances of nursery, 288. 
Nurse and room for infant, 105. 

in confinement, 42-44. 
Nursery, 276, et seq. 

as a hospital, 282. 

floor, ideal. 280. 

how it should be kept, 362. 

nuisances of, 288. 

sunlight in the, 282. 

temperature of, 278, 287. 



Nursery, toys for the, 289. 

turned into a sick-ward, 362, et seq. 

walls, painted, 283. 

windows, 288. 
Nurses, care in selecting, 298. 

carelessness of, 297. 

mother and nature among wisest of, 
16. 

training-schools for, 358. ■ 
Nurses' directories, value of their cer- 
tificates, 94. 
Nursing at each breast alternately, 89, 97. 

directions for, 97-103. 

frequency of, 89, 97, 98. 

good effect on mother's health, 155. 

Miss Catherine Wood on, 358, et seq. 

mother, care in her mode of life, 308. 

of sick children, 357, et seq. 

sleep for mother and child during 
intermissions of. 89. 

the infant, importance of, 73. 

varicose veins in, 99, 100. 

womb reduced to usual size by, 73. 

womb-trouble from not, 155. 
Nursing-bottles, number and size of, 105. 

rules for using, 110. 

success in use of, 106. 



Oatmeal, cautions for the use of, 157. 
Obstruction of larynx, 417, 418. 
Ointments for the child's body, 79. 

in simple surgery, 252. 
Open air for infant, 52. 

fireplace for the nursery. 277. 284. 
Operation, preparing bed for, 372. 
Ophthalmia, contagious, 240, 394. 

in the new-born. 389, 393. 
Out-door exercise, 275. 

for girls, 9, 11. 
Out of doors, at what age a child should 
go. 296. 

child not to be, on an empty stom- 
ach, 300. 
Overclothing, catarrh from, 427. 
Overfeeding a cause of diarrhoea, 349, 
350. 

a cause of sleeplessness, 311, 312., 
Overwork at school, dyspepsia a symp- 
tom of, 183. 

epilepsy from, 186. 
Oxide-of-zinc ointment, 252. 



468 



INDEX. 



P. 

Palate, cleft, 76. 

Pancreas, extract of, 148, 150, 151. 

secretion from the, 140. 
Paper for nursery walls should be var- 
nished, 283. 
Paralysis of the upper eyelid, 398. 
Parents, tactless, 168. 
Parker, Dr., nipple recommended by, 109. 
on American Indian women and in- 
fants, 295. 
Parsons, Dr., disinfecting solution recom- 
mended by, 379. 
Pasteurization, 131. 
Patent sweeper for the nursery, 280. 
Penmanship, " systems" of, 206. 
Pepsin, wine of, 130. 
Peptogenic milk powder, 130. 
Peptonized beef, 322. 

milk, 151. 
Peptonizing food, Mr. Fairchild on, 146- 

150. 
Perception, when beginning in the child, 

94, 95. 
Personal disinfection, Labarraque's solu- 
tion for, 375. 
Phenyle, Little's soluble, in scarlet fever, 

438. 
Philadelphia Board of Health, regula- 
tions for prevention and restriction of 
scarlet fever, etc., 235-241. 
Physical training, 214. 

at Amherst College, 215, 216. 

at Harvard University, 216. 

how much school and college should 

further, 214. 
in primary work, 214. 
moderate exercise sufficient in, 215. 
Physiological laws of distance for the 

eye, 211. 
Pickles, morbid appetite for, 12. 
Pigeon-breast, 217. 
Pillows, hair, 396. 

woven-wire, 396. 
Plants for day-nursery, 280. 
Plaster, adhesive, 250. 
Play better than gymnastics, 217. 

return to English notions of, 182, 183. 
Poisoned wounds, 266. 
Poisoning, aiT- and water-, effects of, 228- 

230. 
Poisons, 268-274. 



Poisons should be marked for safety, 268. 
table of, and treatment for, 272-274. 
to be kept out of reach of children, 

268. 
unknown, 268. 
Pond's extract, 387. 
Positions, faulty, 199, 206. 
Post-nasal catarrh, 382. 
Potassium, bromide of, in teething, 313, 
314. 
permanganate of, prevents putrefac- 
tion in sewage, 380. 
Powder, peptogenic, 130. 
Pregnancy, bathing essential to healthy, 
33, 34. 
blood-poisoning in, 28. 
care of nervous system in, 34, 35. 
cleanliness essential during diseases 

of, 28. 
condition and duty of the mother 

during, 23, 24. 
constipation as affecting, 36. 
diet suited to, 29-31. 
diseases during, 26-29. 
duration of, 22-24. 
exercise and clothing necessary in, 

32,33. 
heart-disease sometimes relieved by 

29. 
hygiene of, 29-42. 
importance of sleep during, 32. 
insanity in, 28. 
natural limit of, 23. 
nervous diseases in, 28. 
normal, 24. 

Saint Vitus's dance in, 28. 
symptoms of, 21, 22. 
temperate and equable climate for, 
41. 
Preparation of bottle, 121, 142. 
Psychical contagion, 185. 
Puberty, period of, 14-16. 

dangers of, 14. 
Public conveyances, care of infants in, 

95, 96. 
Public schools, political management of, 

179, 180. 
Puerperal fever, 60. 

antiseptics for, 61-63. 
Punctured wounds, 246. 
Pupils of the eyes, dilatation of, 389. 
Purgatives, 70. 



INDEX. 



469 



Purgatives, powerful, should not be used 
without consulting a physician, 171. 

Putrefaction, in sewage, prevented by 
permanganate of potassium, 380. 



Recovery of mother in childbirth, 70. 
Regimen for child with the sixteen teeth, 

322, et seq. 
Regularity, importance of, in forming the 

child's first habits, 95. 
Respiration, obstructions to. 252. 

secured while washing the child, 84. 
Respiratory organs, child's requirements 
in diseases of, 367. 
power of, in the new-born child, 79. 
Rickets, 306, et seq. 

a disease of second dentition, 452, 

453. 
cod-liver oil for, 453. 
tendency to, may be outgrown, 452. 
treatment of, 453. 
Rotch, Dr. T. M., on preparation of the 

bottle, 122. 
Running ears, 405, 406. 
Rupture of varicose veins, 40. 



Saint Vitus's dance a disease of bodily 
development, 185. 

child unfitted for school-work by, 
185. 

first step in treatment of, 185. 

spread by psychical contagion among 
children, 185. 

symptoms of, 185. 
Saliva, acidity of, cause of caries, 332. 

free flow of, for teething child, 316. 
Salivary calculus on the teeth, 333. 
Sarco-peptones, Rudisch's, 161. 
Sargent, Dr., his work at Harvard, 216. 
Saunders, John C, M.D.. on " The Anat- 
omy of the Human Ear," 404. 
Scalds, 261. 
Scarlet fever, 233,434, et seq. 

dangers incident to, 438. 

decline of, 438. 

first symptoms of, 436. 

how caused, 434-436. 

scarlatina is, 434. 



Scarlet fever, school-room distribution 
of the poison of, 439. 
what to do for, 436, et seq. 
Schildbach, spirometric observations of, 

196. 
School-day, examples of the routine of a, 
219, 220. 
house windows, 210. 
rooms, ventilation and ■ heating of, 
221. 
Schools, contagious diseases in, 231. 

old-fashioned, fault of, 181. 
Scrofula during time of second dentition, 

449. 
Sea-shore and sea-bathing for children, 

301-302. 
Seat and desk, American model of, 204, 

205. 
Second dentition, 447, et seq. 
disorders attending, 163, 164. 
scrofula during, 449. 
Secretions of the child, attention to the, 

85. 
Sensations, the child's first, 94. 
Serpents, bites of, 267. 
Sewage, 379. 

perchloride of iron for disinfection 

of, 380. 
permanganate of potassium prevents 
putrefaction in, 380. 
Sewerage pipes, in the nursery, to be 

avoided, 278. 
Sick children, Dr. West on treatment of, 
359. 
nursing of, 357, et seq. 
Sickness in a child, signs of, 358, 361. 
Sixteen teeth, regimen for child with the, 

322, et seq. 
Skin, action of, essential to health, 302. 
disorders of, during pregnancy, 37. 
eruptions of, remedied by proper 

bathing, 303. 
grazes of the, 246. 
infant, preventing chafing of, 55. 
Sleep, child should be prepared for, 310. 
for mother and child in intermis- 
sions of nursing, 89. 
ten hours of, for girls, 12. 
Sleeping-apartment of nursery, 276, et seq. 
place, separate, for the infant, 35. 
room, temperature of, 280. 
Sleeplessness arising from pain, 313. 



40 



470 



INDEX. 



Sleeplessness, bromide not to be given 
for, 811. 
caused by overfeeding, 311, 312. 
comes from excitement before sleep- 
time, 310. 
from congestion of the gum and in- 
flammation of the mucous mem- 
brane of the mouth, 315. 
hot foot-bath for, 311. 
in teething, 310. 
insufficient nourishment a cause of, 

311. 
warm Mellin's food and water in 
certain cases of, 311. 
Smith, Dr. J. Lewis, on propagation of 
scarlet fever, 233-235. 
preparation of infant's fcod recom- 
mended by, 142. 
Smith, Eustace, bottle-food for babes 

used by, 129. 
Sniffles, 102. 

Soap and water poisonous to the ear, 400. 
care to use pure, 303. 
Castile, 298, 300. 
Pears' non-scented, 298. 
Social dissipation, girls' health ruined by, 

182. 
Softness of material for infants' garments, 

290. 
Soil, damp, predisposing to consumption, 

192. 
Soldan on neglect of eyesight, 209. 
Soluble phenyle in scarlet fever, 438. 
Sore throat carefully treated, 412. 
Soxhlet, Dr., steam sterilizing of milk 

suggested by, 112. 
Spectator, article in the, 455-457. 
Spinal curvature in schools, prevention 
of, 195. 
deformities of, 192. 
Spines, curved, 169. 
Spirometric observations of Schildbach, 

196. 
Splinters, 266. 

in the eye, 266. 
of glass, 266. 
Splints, 249. 
Sponge-bathing, daily, 12, 

effect of, on woman's beauty, 12. 
Sponges dangerous in treatment of the 

eyes, 390. 
Sprains, 264. 



Sputum, germs of whooping-cough in, 

426. 
Squint, or cross-eye, 398. 
Starchy food alone starvation diet, 
141. 

how to be treated for using, 143. 

malt as an aid to digestion of, 152. 
Steam for disinfection, 375. 

for moistening air of sick-room, 367, 
368. 

sterilizer, best form of, 112. 

sterilizing of milk, 112. 
Stenography and type-writing for women, 

18. 
Sterilization, meaning of, 120. 
Sterilized milk, 96, 106, 108. 
Sterilizer, Arnold steam, 112, 420. 

article of Dr. Walter Mendelson on, 
112-116. 
Sterilizing and sterilizers, 110. 

milk, 111. 
Stimulants, 274. 

and narcotics not to be given, 12. 

frightful abuse of, in painful men- 
struation, 176. 
Stings, 266. 

Stomach, hemorrhage from the, 268. 
Stooping shoulders, 169. 
Stoppage of tear-duct, 397. 
Stoves arranged like portable furnaces, 
225. 

ventilating, of various patterns, 225. 
Strangulation, 252. 
Stroke of lightning, 262. 
Study, injurious habits of, 169. 
Suffocation, 252. 
Sugar of milk. 132. 
Sulphur dioxide, 376. 

fumes of, 376. 
Sunburn, 262. 

Sunlight in the nursery, 282. 
Sunstroke, 263. 

Siippositories for constipation in chil- 
dren, 343, 344. 

glycerin, formula of, 347. 
Surgery, modern, 117. 
Surgical emergencies, 241. 
Sweeper, patent, for the nursery, 280. 
Sweets, mistake to give them to a child 

before eating, 318. 
Swelling of the eyes, 389, 390. 
Syringing the ear, 401. 



INDEX. 



471 



T. 

Tablets for use in milk, 127. 

Tainted milk, 104. 

Talcum, non-scented, best powder to 

prevent chafing, 84. 
Tarrant's aperient, 171". 
Tea, excessive use of, injurious to women, 

12. 
Tear-duct, stoppage of, 397. 
Teeth, acidity of saliva cause of caries 
of, 332. 

attention to decaying, 332. 

care of, during pregnancy, 87. 

care of, in infancy, 289. 

Dr. E. T. Darby on care of, 333-335. 

early, 304. 

eye-, 304. 

large back, 304. 

lateness in cutting, 309. 

premature removal of temporary, 
331. 

preservation of temporary, 331. 

salivary calculus on the, 333. 

sixth-year molar, largest of the per- 
manent, 332. 

structure of the deciduous, 331, 332. 

two lower front, 304. 

usually cut in pairs, 306. 
Teething, 304. 

appearance of mouth at various 
stages of, 305. 

gums in, 304, et seq. 

nature's plan in, 306. 
Temperature of milk, 126. 

of nursery, 278, 287. 

of school-room, 227, 228. 
Test-types for near-sight, 212. 
Thermometer, 430. 

for the nursery, 278, 298. 
Throat and air-passages, diseases of the, 
411, et seq. 

atomizers for sore, 413. 

child with sore, not to go out, 413. 

sore, should be carefully treated, 412. 
Tongue-tie in infants, 76. 
Tonsils, enlargement of, 449. 
Torn wounds, 245. 
Toys for the nursery, 289. 
Training-schools for nurses, advantages 
of, for women, 18. 

noble work of, 358. 



Tuberculosis conveyed through mother's 

milk, 28. 
Turnbull, Dr. Charles S., on diseases of 
the ear, 399, et seq 
on diseases of the eye, 388, et seq. 
Twelfth-year molars, disturbances in 
girls from pressure of, 162. 

U. 

Umbilical cord, stump of the, 85. 
Under flannel cap for babies, 408. 
United States Pharmacopoeia, 122. 

on preparation of lime-water, 122, 123. 
Urine, duty of nurse in measuring and 
recording passage of, 366. 

for testing, 366. 



Valentine's extract of beef, 161. 
Vapor of an alkali in croup, 420. 
Varicella, or chicken-pox, 446, 447. 
Varicose veins, 39, 40. 

in nursing, 99, 100. 

support for, 39. 

treatment of, in case of rupture, 40. 
Varrentrapp, Dr. George, design for desk 

and seat by, 203. 
Vaseline, 252. 

for the eyes, 390. 
Veal-broth for children after weaning, 

322. 
Vegetables, decayed, 274. 

when children may begin to eat, 160. 
Veil for baby's eyes, 52, 53. 
Veins, varicose, 39, 40. 
Ventilating stoves, 285. 
Ventilation, 276, 285, et seq. 

and heating of school-rooms, 221. 

construction of chimneys for, 287. 

fireplaces partial remedies for bad, 
224. 

Jacokes's illustrations of, 226. 

methods of, 224. 
Viability, meaning of, 22. 
Vichy water, 135. 

in croup, 422. 
Vitality, child's, lowered at night, 280. 
Vomiting, how to provoke, 273. 

hysterical, 167. 

with diarrhoea, 357. 



472 



INDEX. 



w. 

Walls, painted, for the nursery, 283. 
Wardrobe, child's, as it should be, 50. 
elaborate, for new-born child use- 
less, 50. 
necessary changes of, 51. 
various kinds of, among different 
nations, 51. 
Warren, Dr. J. C, 196. 
Wash, antiseptic, for eyes, 390. 
Water, acacia, 129. 

as a laxative, 145, 340. 
boiled, 349. 

child's need for drinking, 157, 158. 
cold, for bath, 202. 
drinking-, pure, 279. 
gum-arabic, as nourishment, 154. 
Hunyadi, 178. 
lead-, 252. 
lime-, 122, 123. 
Manitou. 135. 
Vichy, 135. 
Water-drinking, 69. 
Wax in the ear, 406, 407. 
Weakly children, liquid diet for, 325, et 

seq. 
Weaning, 103, 154-162. 

addition of foods in, 159. 

at what age to begin, 154, 155. 

how child's food should be taken 

during the process of, 156. 
should be done by the child itself, 

156. 
too early, 309. 
Well-fed baby, marks of a, 74. 
West, Dr., on treatment of sick children, 

359. 
Wet feet, catarrh from, 427. 
Wet-nurse and bottle compared, 92, 93. 
diet of, 91,92. 
qualifications of, 89, 90. 
selection of, 75, 89-91, 103. 
Whey for the first few weeks of life, use 

of, 128, 129. 
Whooping-cough, 424, et seq. 

aiding the child in detaching mu- 
cus in, 428. 
atomizer in treatment of, 428. 
counter-irritation to the chest useful 

in, 428. 
course of, 426. 



Whooping-cough, duty of the mother in 
nursing, 426. 
fatal in its complications, 424. 
food for a child with, 427, 428. 
germs of, in sputum and secretions 

from the nose, 426. 
good effect of sea-air upon, 426, 427. 
its contagion in the breath, 425. 
less contagious than other maladies, 

425. 
nostrums for, to be avoided, 429. 
pure, fresh air essential in, 426. 
to carry it among healthy children 
almost criminal, 425, 426. 
Windows for the nursery, 288. 
for the school-house, 210. 
Wine of pepsin, 130. 
Wine- whey, 154. 
Womanhood, beginning of, 17. 
foundations of healthy, 9. 
hygiene of, 17-19= 

precaution for health and strength 
of, 17. 
Womb reduced to usual size by nursing, 

73. 
Womb-troubles from menstrual irregu- 
larity, 168. 
Wood, Miss Catherine, on nursing sick 

children, 358, et seq. 
Wool, fine carded, 249. 
Wounded artery, 248. 
Wounds, cleansing of, 250. 

Dr. Charles W. Dulles on treatment 

of, 249-251. 
dressing of, 251. 
dressing-materials for, 249, 250. 
lacerated, 265. 
of the eye, 397. 
poisoned, 266. 
punctured, 246! 
torn or crushed, 245. 
Woven-wire pillows, 396. 
Writing, correct posture in, 206, 207. 
correct slant of letters in, 207. 



Yale, Dr. L. M., on " Nursery Hygiene," 
281, et seq. 



Zvmotic disease, scarlet fever a, 435. 



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others causes them to differ in many points of detail and manage- 
ment, and, in order to make the book cover as large a field as pos- 
sible, they have added much material from the writings of other 
physicians whose opinions have great weight and whose advice is 
of incalculable value." — Preface. 

Hydatid Disease in its Clinical Aspects. 

By James Graham, M.A., M.D. , late Demonstrator of Anatomy, 
Sydney University. Two hundred and four pages. With 34 Full- 
Page Colored Plates from Original Drawings. 8vo. Cloth. $4.50. 
The author's description of the prophylaxis, propagation, and 
mode of infection by the Taenia echinococcus, as well as the 
chapter on hydatid cysts, is remarkably terse, clear, and forcible. 
Too much cannot be said in praise of the thirty-four colored plates 
showing most of the organs affected with this disease. 



For sale by all Booksellers, or will be sent by the Publishers, post-paid, on receipt 
of the price. 

J. B. Lippincott Company, 

715 and 717 Market Street, Philadelphia. 



Standard Medical Books. 



Remington's Pharmacy. 

Second Edition. A Treatise on the Modes of Making and Dispensing 
Officinal, Unofficinal, and Extemporaneous Preparations, with De- 
scriptions of their Properties, Uses, and Doses. By Joseph P. Rem- 
ington, Ph.M., F.C.S. 1300 pages and 630 Illustrations. 8vo. In 
Cloth Binding, $6.00 ; Sheep, $6.50. 

Garretson's Oral Surgery. 

Fifth Edition. A Treatise on the Diseases and Surgery of the Mouth, 
Jaws, Face, Teeth, and Associate Parts. By James E. Garretson, 
A.M., M.D., D.D.S. Illustrated. Thoroughly Revised, with Im- 
portant Additions. 8vo. In Cloth Binding, §9.00 ; Sheep, $10.00. 

Practical Lessons in Nursing. 

i2mo. Extra Cloth. $1.00 each. 

i. The Nursing and Care of the Nervous and 
the Insane. By Chas. k. mills, m.d. 

11. Maternity, Infancy, Childhood. The Hygiene 

of Pregnancy. The Nursing and Weaning of Infants. The 
Care of Children in Health and Disease. By John M. 
Keating, M.D. 

in. Outlines for the Management of Diet; 

or, The Regulation of Food to the Requirements of Health 
and the Treatment of Disease. By E. T. Bruen, M.D. 

IV. Fever-Nursing. By J. C. Wilson, A.M., M.D. 

v. Diseases and Injuries of the Ear: Their Pre- 
vention and Cure. By Charles H. Burnett, A.M., M.D. 
" The instructions contained in these books are applicable to 
almost any form of disease, excepting surgical cases. They can be 
recommended in the strongest terms to nurses and to physicians." — 
Philadelphia Medical and Surgical Reporter. 



For sale by all Booksellers, or will be sent by the Publishers, post-paid, on receipt 
of the price. 

J. B. Lippincott Company, 

715 and 717 Market Street, Philadelphia 



Standard Medical Books. 



Thomas's Medical Dictionary. 

A Complete Pronouncing Medical Dictionary. By Joseph Thomas, 
M.D., LL.D. 844 pages. Imperial 8vo. In Cloth Binding, $5.00; 
Sheep, $6.00. 

" It is just the book for a medical or any other student, and it 
should be in the office of every physician. This dictionary supplies 
a place that has never been filled. I have looked it through and 
find all the new words that I have sought." — Prof. A. F. Patton, 
College of Physicians and Surgeons, Boston, Mass. 

United States Dispensatory. 

New (r6th) Edition. Illustrated. Carefully Revised and Rewritten 
by H. C. Wood, M.D., LL.D., Joseph P. Remington, Ph.M., F.C.S., 
Samuel P. Sadtler, Ph.D., F.C.S. Containing more than 800 pages 
of new material. Green title label distinguishes the binding of the 
Sixteenth Edition. Cloth, Extra, $7.00; Best Leather Raised Bands, 
$8.00; Half Russia, Raised Bands, $9.00. 

Da Costa's Medical Diagnosis. 

Seventh Edition. A Guide to the Knowledge and Discrimination of 
Diseases. By J. M. Da Costa, M.D., LL.D. Revised and En- 
larged. Illustrated. 8vo. In Cloth Binding, $6.00 ; Sheep, $7.00. 



Wood's Therapeutics. 



Eighth Edition. Rearranged, Rewritten, and Enlarged. By H. C. 
Wood, M.D., LL.D. A Work on Medical Agencies, Drugs, and 
Poisons. 8vo. In Cloth Binding, $6.00 ; Sheep, $6.50. 



Agnew's Surgery. 



Second Edition. A Treatise on Surgical Diseases and Injuries. By 
D. Hayes Agnew, M.D., LL.D. Illustrated. Thoroughly Revised, 
with Additions. Three Volumes. 8vo. Price, per Volume : In Cloth 
Binding, $7.50; Sheep, $8. 50. 



For sale by all Booksellers, or will be sent by the Publishers, post-paid, on receipt 
of the p ice. 

J. B. Lippincott Company, 

715 and 717 Market Street, Philadelphia. 



International AMonthly 

Medical * * * "rAtrr 1 

it/r • Science. 

Magazine. * * 

Edited by JUDSON DALAND, M.D. 



Subscription, $4.00 per year. Single numbers, 33 cents. 



"CACH number of the magazine contains more than one hundred 
pages, and is made up of original contributions, clinical lectures, 
review of medicine, and book reviews. The enormous mass of con- 
temporaneous medical literature is carefully read, and contributions 
possessing real worth are reviewed in a crisp and concise manner. 

All important articles appearing in German, French, Italian, and 
Spanish medical periodicals, as well as in English, receive careful 
attention in the following departments: Therapeutics, Medicine, 
Neurology, Pediatrics, Surgery, Genito-Urinary Surgery, 
Orthopaedics, Gynecology and Obstetrics, Ophthalmology, 
Laryngology and Rhinology, Dermatology, Pathology, Hy- 
giene and Bacteriology, Climatology, and Forensic Medicine. 

Each number is illustrated with reproductions from photographs or 
original drawings, wherever their presence will serve to explain the 
text and help the reader to a ready and accurate apprehension of the 
subject-matter. 

The hearty commendation accorded by physicians to the efforts 
of the publishers in this direction in the past, encourages them to 
spare neither money nor skill where illustrations will lighten the 
labor of the practitioner or add to the attractive appearance of the 
magazine. 

Subscriptions may commence at any time. 



Sample Copy sent on Application. 



For further particulars address the publishers, 

J. B. Lippincott Company, 

715 and 717 Market Street, Philadelphia. 



oct -0 m 



